Pediatric neurogenic stunned myocardium due to blunt head trauma requiring ECMO

Abstract

We present a case of a child with severe cardiogenic shock due to neurogenic stunned myocardium (NSM) caused by severe traumatic brain injury who was successfully treated with venoarterial extracorporeal membrane oxygenation (VA-ECMO). The patient—a healthy 13-year-old boy—presented to the emergency department with a single head injury due to a fall. Computed tomography revealed an acute epidural hematoma. An emergency surgery was planned. However, ventricular fibrillation was detected prior to surgery, and the patient was resuscitated. Postoperatively, severe cardiogenic shock was observed. VA-ECMO was introduced upon NSM diagnosis, and the patient had a good clinical course. NSM is a form of transient cardiac dysfunction associated with acute central nervous system injury and is rare in children. Most cases improve with conservative treatment. However, VA-ECMO may be considered in cases of severe cardiogenic shock. The choice of the site for ECMO cannulation should be carefully considered in pediatric patients.

Keywords

• Cardiology
• Extracorporeal membrane oxygenation
• Critical care
• Neurosurgery
• Trauma