Spinal Cord Infarction With Prolonged Femoral Venoarterial Extracorporeal Membrane Oxygenation.
J Cardiothorac Vasc Anesth
; 37(5): 758-766, 2023 05.
Article
in En
| MEDLINE
| ID: mdl-36842938
ABSTRACT
OBJECTIVES:
There have been sporadic reports of ischemic spinal cord injury (SCI) during venoarterial extracorporeal membrane oxygenation (VA-ECMO) support. The authors observed a troubling pattern of this catastrophic complication and evaluated the potential mechanisms of SCI related to ECMO.DESIGN:
This study was a case series.SETTING:
This study was performed at a single institution in a University setting.PARTICIPANTS:
Patients requiring prolonged VA-ECMO were included.INTERVENTIONS:
No interventions were done. This was an observational study. MEASUREMENTS AND MAINRESULTS:
Four hypotheses of etiology were considered (1) hypercoagulable state/thromboembolism, (2) regional hypoxia/hypocarbia, (3) hyperperfusion and spinal cord edema, and (4) mechanical coverage of spinal arteries. The SCI involved the lower thoracic (T7-T12 level) spinal cord to the cauda equina in all patients. Seven out of 132 (5.3%) patients with prolonged VA-ECMO support developed SCI. The median time from ECMO cannulation to SCI was 7 (range 6-17) days.There was no evidence of embolic SCI or extended regional hypoxia or hypocarbia. A unilateral, internal iliac artery was covered by the arterial cannula in 6/7 86%) patients, but flow into the internal iliac was demonstrated on imaging in all available patients. The median total flow (ECMO + intrinsic cardiac output) was 8.5 L/min (LPM), and indexed flow was 4.1 LPM/m2. The median central venous oxygen saturation was 88%, and intracranial pressure was measured at 30 mmHg in one patient, suggestive of hyperperfusion and spinal cord edema.CONCLUSIONS:
An SCI is a serious complication of extended peripheral VA-ECMO support. Its etiology remains uncertain, but the authors' preliminary data suggested that spinal cord edema from hyperperfusion or venous congestion could contribute.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Spinal Cord Injuries
/
Extracorporeal Membrane Oxygenation
/
Spinal Cord Ischemia
Type of study:
Etiology_studies
/
Observational_studies
Limits:
Humans
Language:
En
Journal:
J Cardiothorac Vasc Anesth
Journal subject:
ANESTESIOLOGIA
/
CARDIOLOGIA
Year:
2023
Type:
Article