Multiple decompressive craniectomies and hematoma evacuation in a patient undergoing extracorporeal membrane oxygenation

Abstract

Extracorporeal membrane oxygenation (ECMO) is well studied in the use of cardiopulmonary resuscitation with known neurologic complications. In this case study, we present the case of an 18-year-old female who underwent ECMO cannulation and systemic anticoagulation after cardiac arrest and subsequently developed a large intracerebral hemorrhage. She underwent decompressive hemicraniectomy and hematoma evacuation twice with excellent neurologic outcome. While several studies in the literature describe surgical interventions undertaken while on ECMO, few describe successful outcomes after neurosurgical procedures. Our case study is the first to document the successful result of craniotomy twice while on ECMO, and it illustrates the importance of repeat imaging on patients identified to have any intracranial hemorrhage after ECMO cannulation. This case illustrates that neurosurgical intervention can be performed in appropriate circumstances with successful outcomes in carefully selected patients undergoing ECMO, and ECMO should not be considered an absolute contraindication for surgery in life-threatening situations.

Keywords

• Decompressive craniectomy
• Extracorporeal membrane oxygenation
• Intracerebral hemorrhage