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Spinal Cord Infarction With Prolonged Femoral Venoarterial Extracorporeal Membrane Oxygenation
Chetan Pasrija1, Zachary N Kon2, Michael A Mazzeffi3
1Division of Cardiac Surgery, University of Maryland, School of Medicine, Baltimore, MD.
Journal of Cardiothoracic and Vascular Anesthesia
|February 26, 2023
Summary
Spinal cord injury (SCI) is a serious complication of venoarterial extracorporeal membrane oxygenation (VA-ECMO). Preliminary findings suggest spinal cord edema from hyperperfusion may contribute to SCI during VA-ECMO.
Area of Science:
- Neurology
- Cardiology
- Critical Care Medicine
Background:
- Ischemic spinal cord injury (SCI) is a rare but devastating complication during venoarterial extracorporeal membrane oxygenation (VA-ECMO) support.
- Sporadic reports highlight the need to understand the mechanisms behind SCI in patients on VA-ECMO.
Purpose of the Study:
- To investigate the potential mechanisms contributing to spinal cord injury (SCI) in patients undergoing prolonged venoarterial extracorporeal membrane oxygenation (VA-ECMO) support.
- To evaluate the incidence and etiological factors of SCI in a cohort of patients on VA-ECMO.
Main Methods:
- This study employed a case series design, retrospectively analyzing patients requiring prolonged VA-ECMO at a single university institution.
- Data were collected to assess four proposed hypotheses: hypercoagulable state/thromboembolism, regional hypoxia/hypocarbia, hyperperfusion/spinal cord edema, and mechanical coverage of spinal arteries.
Main Results:
- Seven out of 132 (5.3%) patients developed SCI, primarily affecting the lower thoracic spinal cord to the cauda equina.
- No evidence of embolic SCI or extended regional hypoxia/hypocarbia was found.
- While arterial cannula coverage of the internal iliac artery occurred in most cases, flow was preserved. However, high total and indexed flow rates, along with elevated intracranial pressure in one case, suggested hyperperfusion and spinal cord edema.
Conclusions:
- Spinal cord injury (SCI) is a significant complication associated with extended peripheral VA-ECMO.
- The etiology of SCI remains unclear, but preliminary findings indicate that spinal cord edema resulting from hyperperfusion or venous congestion may play a contributing role.
