Successful embolization of aneurysms in deep coma patients with subarachnoid haemorrhage receiving ECMO support: a...

ECMO is an advanced technology for extracorporeal respiratory and circulatory support. It involves the extraction of venous blood from the patient's body, which is subsequently oxygenated within an oxygenator (or membrane lung). This oxygen-rich blood is reinfused either into veins or arteries, rapidly compensating for impaired lung and heart functionalities. ECMO mirrors the essential processes of cardiac output in facilitating tissue perfusion and gas exchange, thereby expanding the therapeutic window for critically ill patients with acute circulatory insufficiency, and enabling restoration of cardiopulmonary function. We report a 55-year-old woman with no prior significant health issues who suddenly experienced headache accompanied by nausea and vomiting while resting at home. A small amount of gastric content was vomited, and no specific treatment was administered. Two hours later, she was found unconscious on the bathroom floor, with her mouth and nose filled with vomit, loss of consciousness, dyspnea, and urinary incontinence. A cranial CT scan revealed "subarachnoid hemorrhage with left frontal lobe cerebral hemorrhage extending into the ventricular system". Despite intervention, the peripheral blood oxygen saturation rapidly dropped to 70%. The electrocardiogram showed sinus rhythm with abnormal ST-T changes. Subsequently, the ECMO (Extracorporeal Membrane Oxygenation) specialized treatment team performed a bedside ultrasound-guided Veno-Arterial (V-A) ECMO implantation procedure for the patient. Given that cranial CTA imaging demonstrated a 5 mm × 5 mm × 7 mm wide-necked aneurysm with an irregular shape at the M1 bifurcation of the left middle cerebral artery, this aneurysm was deemed the culprit lesion responsible for the rupture and bleeding. Consequently, an ECMO-supported cerebral aneurysm stent-assisted embolization procedure was carried out. Following anticoagulation, anti-infection therapy, continuous cerebrospinal fluid drainage, nimodipine infusion to prevent cerebral vasospasm, and traditional Chinese medicine rehabilitation treatment, the patient regained spontaneous respiration on the 5th day after surgery. She was successfully discharged from the hospital on the 26th day post-surgery. Thus, ECMO-supported stent-assisted embolization treatment modality is feasible for patients with ruptured cerebral aneurysms and subarachnoid hemorrhage. However, the value of ECMO in recovering consciousness among patients with ruptured cerebral aneurysm and subarachnoid hemorrhage-induced coma requires further validation through a larger number of cases.