The Use of Anticoagulation for Patients With Traumatic Brain Injury on Extracorporeal Membrane Oxygenation

Traumatic brain injury (TBI) affects approximately 69 million people worldwide annually, making it one of the most common neurologic injuries. The highest incidence worldwide is reported in North America, with an average of 600,000 TBI-related emergency department visits annually. Trauma patients with either TBI or polytrauma with TBI components can develop acute respiratory distress syndrome (ARDS) due to pulmonary contusion, the sequelae of nonthoracic trauma, or the resuscitation related to hemorrhagic shock. ARDS results in life-threatening hypoxemic respiratory failure, often refractory to conventional treatment, and it is sometimes managed with extracorporeal membrane oxygenation (ECMO). However, TBI has historically been contraindicated for ECMO use because of the use of systemic anticoagulation in ECMO that can worsen or cause new intracranial bleeding. Emerging literature suggests that ECMO use can reduce mortality in patients with TBI and concurrent ARDS, and several case reports and retrospective studies show efficacy of various anticoagulation strategies. This study outlines various anticoagulation approaches for patients with TBI on ECMO and reports their complications and outcomes.