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Complications neurologiques de l’assistance circulatoire de courte durée

Neurological complications during short-term circulatory support

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Médecine Intensive Réanimation

Résumé

L’assistance circulatoire type extracorporeal membrane oxygenation (ECMO) peut être utilisée en cas de défaillances respiratoires et/ou circulatoires réfractaires aux traitements conventionnels. Son utilisation est en constante augmentation, et associée à la survenue de complications du système nerveux, responsables d’une morbimortalité élevée. Les complications neurologiques observées sous ECMO sont principalement cérébrovasculaires, accident vasculaire cérébral ischémique (AVCi) et hémorragie intracrânienne (HIC). De nombreux éléments antérieurs à l’implantation de l’ECMO peuvent être associés à la survenue de lésions neurologiques, mais certaines complications neurologiques sont plus fréquemment observées selon le type d’ECMO utilisée. Les AVCi surviennent principalement chez les patients sous ECMO-veinoartérielle, alors que les HIC sont surtout observés chez les patients sous EMCO-veinoveineuse. La survenue de ces complications neurologiques a un impact sur les choix thérapeutiques, reposant sur l’estimation multidisciplinaire du rapport bénéfice/risque. Leur détection précoce pourrait améliorer le pronostic des patients.

Abstract

Extracorporeal membrane oxygenation (ECMO) is used to support patients with respiratory and/or circulatory failure refractory to conventional therapies. Its use is increasing and associated with nervous system complications, responsible for high morbidity and mortality. These neurological events are mainly cerebrovascular in nature; that is, ischemic stroke and cerebral hemorrhage. Many pre-ECMO factors are associated with neurological injury but during the course of ECMO, the modality used is also diversely associated with nervous system complication. Stroke occurs mainly during venoarterial ECMO, whereas cerebral hemorrhage is mostly observed during venovenous ECMO. These complications have an important impact in terms of outcome, and consequently on multidisciplinary teams decisions. Early detection and specific care for neurological complications could improve the prognosis of these patients.

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Authors and Affiliations

  1. Service de réanimation, ICAN, groupe hospitalier Pitié–Salpêtrière, 47–83, boulevard de l’Hôpital, F-75651, Paris cedex 13, France

    C.-E. Luyt

  2. Service de réanimation, institut de cardiologie, groupe hospitalier Pitié–Salpêtrière, Assistance publique–Hôpitaux de Paris, F-75013, Paris, France

    L. Le Guennec, M. Schmidt, N. Bréchot, A. Combes & C.-E. Luyt

  3. Inserm, UMRS_1166-ICAN, UPMC université Paris-VI, Institute of Cardiometabolism and Nutrition, Sorbonne Universités, F-75013, Paris, France

    L. Le Guennec, M. Schmidt, N. Bréchot, G. Lebreton, P. Leprince, A. Combes & C.-E. Luyt

  4. Service de chirurgie thoracique et cardiovasculaire, institut de cardiologie, groupe hospitalier Pitié–Salpêtrière, Assistance publique–Hôpitaux de Paris, F-75013, Paris, France

    G. Lebreton & P. Leprince

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  1. L. Le Guennec
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  2. M. Schmidt
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  3. N. Bréchot
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  6. A. Combes
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Correspondence to C.-E. Luyt.

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Le Guennec, L., Schmidt, M., Bréchot, N. et al. Complications neurologiques de l’assistance circulatoire de courte durée. Réanimation 25 (Suppl 4), 150–160 (2016). https://doi.org/10.1007/s13546-016-1217-4

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  • DOI: https://doi.org/10.1007/s13546-016-1217-4

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