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Veno-Venous Extracorporeal Membrane Oxygenation in a Mouse
Published on: October 24, 2018
Managing medically refractory elevated intracranial pressure in a pediatric patient on ECMO: illustrative case
Tirone Young1, Bahie Ezzat1, Noah Nichols1
1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
Insights
Managing children on extracorporeal membrane oxygenation (ECMO) therapy who need neurosurgery is complex. Successful outcomes require careful balancing of anticoagulation, cardiac function, and intracranial pressure (ICP) with multidisciplinary care.
Area of Science:
- Pediatric critical care medicine
- Neurosurgery
- Cardiovascular surgery
Background:
- Extracorporeal membrane oxygenation (ECMO) is a life-support measure for critically ill children with cardiorespiratory failure.
- Neurosurgical interventions in pediatric patients on ECMO present unique management challenges.
- Managing systemic anticoagulation, cardiac function, and intracranial pressure (ICP) are critical considerations.
Observation:
- A case series involving five pediatric patients requiring neurosurgery while on ECMO was analyzed.
- The primary case involved a 3.5-year-old female with Tetralogy of Fallot who developed cerebral edema post-cardiac arrest and required ECMO.
- This patient underwent emergency neurosurgical intervention.
Findings:
- Neurosurgical intervention in the primary case resulted in significant clinical improvement.
- The management highlighted the critical balance between ECMO-induced anticoagulation and the demands of neurosurgery.
- Outcomes in the additional cases were variable, underscoring the complexity of these scenarios.
Implications:
- Multidisciplinary collaboration is essential for optimizing outcomes in pediatric ECMO patients undergoing neurosurgery.
- This report details nuances in decision-making for complex cases.
- Successful management strategies can lead to favorable outcomes in critically ill pediatric patients.
Purpose:
We demonstrate the complexities of managing pediatric patients on extracorporeal membrane oxygenation (ECMO) therapy requiring neurosurgery, focusing on systemic anticoagulation, cardiac function, and medically refractory intracranial pressure (ICP).
Methods:
A 3.5-year-old female with Tetralogy of Fallot developed severe ischemic cerebral edema following post-operative cardiac arrest and required ECMO. This case, along with four additional cases of children requiring neurosurgery while on ECMO, was examined.
Results:
Emergency neurosurgical intervention in the primary case led to significant improvement, highlighting the delicate balance between managing ECMO-induced anticoagulation and urgent neurosurgical needs. The additional cases had variable outcomes, emphasizing the challenges of caring for these critically ill patients.
Conclusion:
Successful management of children requiring ECMO support and neurosurgical intervention requires thoughtful multidisciplinary care. This report illustrates some of the nuances in such decision-making, and demonstrates one potential path to a good outcome.
