Abstract
Objective
There have been sporadic reports of ischemic spinal cord injury (SCI) during VA-ECMO
support. We observed a troubling pattern of this catastrophic complication and evaluated
the potential mechanisms of SCI related to ECMO.
Design
This study is a case series.
Setting
This study was performed at a single institution in a University setting.
Participants
Patients requiring prolonged VA-ECMO was performed
Interventions
No interventions were done. This was an observational study.
Measurements and Main Results
Four hypotheses of etiology were considered: 1) hypercoagulable state/thromboembolism;
2) regional hypoxia/hypocarbia; 3) hyperperfusion and spinal cord edema; 4) mechanical
coverage of spinal arteries. SCI involved the lower thoracic (T7-T12 level) spinal
cord to the cauda equina in all patients.
7/132 (5.3%) patients with prolonged VA-ECMO support developed SCI. 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 patients, but flow into the internal iliac
was demonstrated on imaging in all available patients. Median total flow (ECMO + intrinsic
cardiac output) was 8.5 LPM and indexed flow was 4.1 LPM/m2. Median central venous
oxygen saturation was 88%, and intra-cranial pressure was measured at 30mmHg in one
patient, suggestive of hyperperfusion and spinal cord edema.
Conclusion
SCI is a serious complication of extended peripheral VA-ECMO support. Its etiology
remains uncertain but our preliminary data suggest that spinal cord edema from hyperperfusion
or venous congestion could contribute.
Keywords
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Article info
Publication history
Publication stage
In Press Accepted ManuscriptFootnotes
Funding Sources: This study was supported by funding from the Division of Cardiac Surgery
Identification
Copyright
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