{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,21]],"date-time":"2026-06-21T21:48:07Z","timestamp":1782078487235,"version":"3.54.5"},"reference-count":33,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T00:00:00Z","timestamp":1781654400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100000002","name":"NIH","doi-asserted-by":"publisher","award":["1K23HL157610"],"award-info":[{"award-number":["1K23HL157610"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"NIH","doi-asserted-by":"publisher","award":["1R21NS135045"],"award-info":[{"award-number":["1R21NS135045"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000185","name":"DARPA","doi-asserted-by":"crossref","award":["HR001124S0024"],"award-info":[{"award-number":["HR001124S0024"]}],"id":[{"id":"10.13039\/100000185","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Hyperfine Inc."},{"DOI":"10.13039\/100031653","name":"NeurOptics","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100031653","id-type":"DOI","asserted-by":"crossref"}]},{"name":"StellarCube Inc."},{"DOI":"10.13039\/100008454","name":"ASPEN Rhoads Research Foundation","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100008454","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Perfusion"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Postcardiotomy cardiogenic shock (PCS) is a life-threatening complication after adult cardiac surgery that frequently necessitates venoarterial extracorporeal membrane oxygenation (VA-ECMO). Central and peripheral VA-ECMO cannulation strategies generate distinct hemodynamic and perfusion profiles; however, whether these differences translate into varying risks of acute brain injury (ABI) remains uncertain. We therefore compared ABI risk according to cannulation strategy in adults with PCS requiring VA-ECMO, with secondary objectives to determine the overall prevalence of ABI and characterize its major subtypes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We systematically searched PubMed, Embase, Cochrane Library, Web of Science, and Scopus through April 15, 2025, for studies reporting ABI in adult PCS patients receiving VA-ECMO. ABI outcome was defined as ischemic stroke, intracranial hemorrhage, hypoxic-ischemic brain injury, seizures, unspecified stroke, and brain death. Random-effects meta-analysis was performed, incorporating a contemporary single-center cohort from Johns Hopkins Hospital (2020\u20132025).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The primary meta-analysis included seven cohorts (six published studies plus Johns Hopkins cohort;\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 2536), while secondary analyses included 17 cohorts (16 published studies plus Johns Hopkins cohort). Included patients (mean age = 65\u00a0years, BMI = 28\u00a0kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      , 61% male) underwent central VA-ECMO cannulation in 32% and peripheral cannulation in 68%. The pooled risk of ABI did not differ by cannulation strategy (risk ratio [RR], 1.01; 95% CI, 0.85\u20131.21;\n                      <jats:italic toggle=\"yes\">I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      = 0%), with similar ABI prevalence across groups (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.99). Ischemic stroke and unspecified stroke were the most reported subtypes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In adults with PCS supported by VA-ECMO, the risk of ABI was not significantly associated with cannulation strategy. These findings suggest that cannulation approach alone is unlikely to be the primary determinant of neurological risk in this population, underscoring the need for systematic neuroprotective strategies regardless of cannulation configuration.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/02676591261462283","type":"journal-article","created":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T10:05:04Z","timestamp":1781690704000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Acute brain injury in adult post-cardiotomy cardiogenic shock patients receiving central vs. peripheral VA-ECMO: A single-center experience and systematic review with meta-analysis"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-8196-5985","authenticated-orcid":false,"given":"Juyeon","family":"Ryu","sequence":"first","affiliation":[{"name":"Soonchunhyang University College of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-7713-1930","authenticated-orcid":false,"given":"Yiting","family":"Lin","sequence":"additional","affiliation":[{"name":"Johns Hopkins University School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyun Yi (Jacqualine)","family":"Woo","sequence":"additional","affiliation":[{"name":"Johns Hopkins University School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmad","family":"Hamid","sequence":"additional","affiliation":[{"name":"Drexel University College of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madison","family":"Malfitano","sequence":"additional","affiliation":[{"name":"Johns Hopkins University School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Parth","family":"Sutariya","sequence":"additional","affiliation":[{"name":"Drexel University College of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin","family":"Lu","sequence":"additional","affiliation":[{"name":"Drexel University College of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melanie","family":"Crasta","sequence":"additional","affiliation":[{"name":"Lake Erie College of Osteopathic Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdullah","family":"Mahmood","sequence":"additional","affiliation":[{"name":"Drexel University College of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0456-1230","authenticated-orcid":false,"given":"Yaman B.","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Johns Hopkins University School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcus","family":"Spann","sequence":"additional","affiliation":[{"name":"Johns Hopkins School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Glenn J. R.","family":"Whitman","sequence":"additional","affiliation":[{"name":"Johns Hopkins University School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sung-Min","family":"Cho","sequence":"additional","affiliation":[{"name":"Johns Hopkins University School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,6,17]]},"reference":[{"issue":"1","key":"e_1_3_5_2_2","first-page":"67","article-title":"Central versus peripheral arterial cannulation for veno-arterial extracorporeal membrane oxygenation in post-cardiotomy patients","volume":"67","author":"Radakovic D","year":"2021","unstructured":"Radakovic D, Hamouda K, Penov K, et al. Central versus peripheral arterial cannulation for veno-arterial extracorporeal membrane oxygenation in post-cardiotomy patients. 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The Newcastle-Ottawa scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Published online. https:\/\/scholar.archive.org\/work\/zuw33wskgzf4bceqgi7opslsre\/access\/wayback\/. https:\/\/www3.med.unipmn.it\/dispense_ebm\/2009-2010\/Corso_Perfezionamento_EBM_Faggiano\/NOS_oxford.pdf (2000 accessed 6 August 2024)."},{"key":"e_1_3_5_20_2","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000003223"},{"key":"e_1_3_5_21_2","doi-asserted-by":"publisher","DOI":"10.1177\/02676591221119312"},{"issue":"1","key":"e_1_3_5_22_2","first-page":"111","article-title":"Predictors and outcomes of acute brain injury in patients on venoarterial extracorporeal membrane oxygenation after cardiopulmonary resuscitation","volume":"40","author":"Ou CY","year":"2024","unstructured":"Ou CY, Tsai MT, Wang YC, et al. Predictors and outcomes of acute brain injury in patients on venoarterial extracorporeal membrane oxygenation after cardiopulmonary resuscitation. 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Impact of pulse pressure on acute brain injury in venoarterial ECMO patients with cardiogenic shock during the first 24 hours of ECMO cannulation: analysis of the extracorporeal life support organization registry. Review 2023. 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