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Spinal Cord Infarction With Prolonged Femoral Veno-Arterial Extracorporeal Membrane Oxygenation

Published:January 04, 2023DOI:https://doi.org/10.1053/j.jvca.2022.12.025

      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.

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