Extracorporeal membrane oxygenation-related spinal cord infarction: A case report

Abstract

Extracorporeal membrane oxygenation (ECMO) is a high-risk extracorporeal technique that serves as an effective last-ditch salvage therapy for patients with severe heart or respiratory failure. The most common complications observed after ECMO include hypoxic and vascular lesions (ischemic or hemorrhagic). Neurologic complications contribute to a proportion of post-treatment morbidity and mortality but have seldom been well described. We present the case of a 26-year-old man with complications related to influenza A pneumonia and who experienced sudden-onset paraplegia after undergoing ECMO. A magnetic resonance imaging scan revealed spinal infarction at the T9 to L1 level, likely involving the artery of Adamkiewicz. This may be attributed to spinal hypoperfusion or thromboembolism. Similar previously reported cases show a large variation in the ECMO duration; however, the venoarterial mode of ECMO was commonly used in cases involving this complication. Although spinal infarction is rarely reported to occur in clinical practice after ECMO complications, it requires a high index of suspicion for recognition. Close monitoring of coagulation and platelet count and electrophysiological recording during ECMO may be useful in early detection and prevention of complications.

Keywords

• Artery of Adamkiewicz
• Hypotension
• Influenza
• Paraplegia
• Spinal cord