Spinal cord infarction during venoarterial-extracorporeal membrane oxygenation support
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CASE REPORT Artificial Lung / ECMO
Spinal cord infarction during venoarterial‑extracorporeal membrane oxygenation support Loïc Le Guennec1 · Natalia Shor1 · Bruno Levy2 · Guillaume Lebreton1 · Pascal Leprince1 · Alain Combes1 · Didier Dormont1 · Charles‑Edouard Luyt1 Received: 31 December 2019 / Accepted: 28 April 2020 © The Japanese Society for Artificial Organs 2020
Abstract Spinal cord infarction (SCI) is a rare disease among central nervous system vascular diseases. Only a little is known about venoarterial extracorporeal membrane oxygenation (VA-ECMO)-related SCI. Retrospective observational study conducted, from 2006 to 2019, in a tertiary referral center on patients who developed VA-ECMO-related neurovascular complications, focusing on SCI. During this period, among the 1893 patients requiring VA-ECMO support, 112 (5.9%) developed an ECMOrelated neurovascular injury: 65 (3.4%) ischemic strokes, 40 (2.1%) intracranial bleeding, one cerebral thrombophlebitis (0.05%) and 6 (0.3%) spinal cord infarction. Herein, we report a series of six patients with refractory cardiogenic shock or cardiac arrest receiving circulatory support with VA-ECMO who developed subsequent SCI during ECMO course, confirmed by spine MRI after ECMO withdrawal. All six patients had long-term neurological disabilities. VA-ECMO-related SCI is a rare but catastrophic complication. Its diagnosis is usually delayed due to sedation requirement and/or ICU acquired weakness after sedation withdrawal, leading to difficulties in monitoring their neurological status. Even if no specific treatment exist for SCI, its prompt diagnosis is mandatory, to prevent secondary spine insults of systemic origin. Based on these results, we suggest that daily sedation interruption and neurological exam of the lower limbs should be performed in all VA-ECMO patients. Large registries are mandatory to determine VA-ECMO-related SCI risk factor and potential therapy. Keywords Extracorporeal membrane oxygenation · Intra-aortic balloon pump · Spinal cord infarct · Neurological examination · Sedation withdrawal · Secondary spine insults of systemic origin
Introduction Spinal cord infarction (SCI) is a rare disease among central nervous system vascular diseases. Causes of SCI can be idiopathic (28%), degenerative spine disease (15.8%), associated to aortic pathology with or without surgery (15.8%), epidural anesthesia (1.8%), arteriosclerosis (33.3%), cardiac embolism (3.5%), or secondary to an acute systemic hypoperfusion (1.8%) [1]. It is often associated with severe Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10047-020-01179-8) contains supplementary material, which is available to authorized users. * Loïc Le Guennec [email protected] 1
Hopital Universitaire Pitie Salpetriere, Paris, France
Universite de Lorraine, Nancy, France
2
prognosis and permanent sequelae [1, 2]. Coronary angiography and intra-aortic balloon pump (IABP) may cause SCI [3–5], as well as venoarterial-extracorporeal membrane o
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