Abstract
Extracorporeal membrane oxygenation (ECMO) is a life-saving mechanical respiratory and/or circulatory support for potentially reversible severe heart or respiratory injury untreatable with conventional therapies. Thanks to the technical and management improvements the use of ECMO has increased dramatically in the last few years. Data in the literature show a progressive increase in the overall outcome. Considering the improving survival rate of patients on ECMO, and the catastrophic effect of neurological injuries in such patients, the topic of neurological damage during the ICU stay in ECMO is gaining importance. We present a case series of six neurological injuries that occurred in 1 year during the ECMO run or after the ECMO weaning. In each case the neurological complication had a dramatic effect: ranging from brain death to prolonged ICU stay and long term disability. This case series has an informative impact for the multidisciplinary teams treating ECMO patients because of its heterogeneity in pathogenesis and clinical manifestation: cerebral hemorrhage, ischemic stroke due to cerebral fat embolism, acute disseminated encephalomyelitis due to H1N1 Influenza. In our ECMO hub we started strict neurological monitoring involving intensivists, a neurologist and our radiology service, but neurological complications are still an insidious diagnosis and treatment. Considering several possible neurological injuries may help reduce delay in diagnosis and speed rehabilitation.
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Acknowledgments
We are indebted to Warren Blumberg, science editor at ISMETT, for his help in revising the manuscript. We are indebted to Fabio Tuzzolino, of ISMETT’s Research Office, for his help in data management and analysis.
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All procedures performed in the cases reported are in accordance with the ethical standards of our institute’s IRRB, and with the 1964 Declaration of Helsinki and its later amendments. Informed consent is not applicable for this type of patient, but consent for anonymous data publication was given from relatives.
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The authors declare no conflict of interests.
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The investigators of this manuscript did not received any found for this work.
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Martucci, G., Lo Re, V. & Arcadipane, A. Neurological injuries and extracorporeal membrane oxygenation: the challenge of the new ECMO era. Neurol Sci 37, 1133–1136 (2016). https://doi.org/10.1007/s10072-016-2515-z
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DOI: https://doi.org/10.1007/s10072-016-2515-z