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Published on: January 17, 2025
Peripheral neuropathy after extra-corporeal membrane oxygenation therapy in children: A case report
Jun Young Ko1, Mi Rim Lee1, Eun-Hye Ha2
1Department of Rehabilitation Medicine, Myongji Hospital, 14-55 Hwasu-ro, Deokyang-gu, Goyang-si, Gyeonggi-do, Republic of Korea.
Insights
Extracorporeal membrane oxygenation (ECMO) can cause rare peripheral nerve injuries in children. Early diagnosis and monitoring are crucial for managing these complications and improving patient outcomes.
Area of Science:
- Pediatric critical care medicine
- Neurology
- Cardiovascular surgery
Background:
- Extracorporeal membrane oxygenation (ECMO) use in pediatric cardiorespiratory failure is increasing.
- Central nervous system complications are reported, but peripheral nerve injuries are rare, especially in children.
- This study highlights previously undocumented peripheral nerve injuries in pediatric ECMO patients.
Observation:
- Two pediatric patients (ages 16 and 6) developed motor weakness in extremities post-ECMO.
- Electrodiagnostic studies revealed femoral/sciatic neuropathies and brachial plexopathy.
- Potential causes identified include vascular compromise and compressive injuries.
Findings:
- Prompt diagnosis through electrodiagnostic studies is essential.
- Interventions included surgical embolectomy, orthosis, physical therapy, and occupational therapy.
- Both patients demonstrated gradual improvement in motor power and function.
Implications:
- This case report emphasizes the importance of recognizing and monitoring for peripheral nerve injuries in pediatric ECMO patients.
- Early detection and management can lead to improved functional recovery.
- Further research into ECMO-related pediatric nerve complications is warranted.
Rationale:
In recent years, the use of extracorporeal membrane oxygenation (ECMO) treatment for pediatric patients with cardiorespiratory failure has increased, with emphasis being given to the prevention of complications in ECMO-treated patients. Several studies have reported ECMO-related central nervous system complications, such as intracranial hemorrhage, cerebral infarction, and seizure. However, few cases of peripheral nerve injury have been reported in ECMO-treated adults; there have also been no reported cases of peripheral nerve injury in the pediatric population.
Patient Concerns:
Two pediatric patients aged 16 and 6 experienced motor weakness in the extremities after the insertion of ECMO equipment.
Diagnoses:
They were diagnosed with peripheral nerve injuries through an electrodiagnostic study that showed femoral/sciatic neuropathies and brachial plexopathy. Arteriography and doppler sonography was performed to find the cause of peripheral nerve injury, and this may be the results of vascular compromise and compressive injuries, respectively.
Interventions:
Surgical embolectomy was performed to remove thrombus in one patient. Two patients received orthosis, and physical therapy and occupational therapy were performed to prevent contracture and improve strength and functional use.
Outcomes:
Two pediatric patients showed a gradual improvement in motor power and function.
Lessons:
Through this case report, we present rare ECMO-related complications and emphasize the importance of early diagnosis and monitoring of peripheral nerve injury in ECMO-treated children.
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