This retrospective TriNetX study compared 30-day neurologic outcomes in adults receiving VA versus VV ECMO during 2015–2024, with 6,944 patients per group after propensity matching. Cerebral infarction occurred in 7.04% versus 5.13%, respectively (OR 1.40, 95% CI 1.22–1.61). VA ECMO was also associated with higher odds of seizures, hypoxic-ischemic encephalopathy and brain death; hemorrhagic stroke showed no statistically clear difference (OR 0.83, 95% CI 0.66–1.04). The authors emphasized that hypoxic-ischemic endpoints could not be separated from the indication for VA support and reflected burden rather than modality effect.
VA ECMO recipients had greater observed ischemic and hypoxic-ischemic neurologic burden than matched VV recipients. These associations do not establish that ECMO configuration caused the differences.
Study limitation: Retrospective propensity matching cannot separate hypoxic-ischemic outcomes from the indication for VA support or establish a causal modality effect.
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