Spinal Cord Infarction With Prolonged Femoral Venoarterial Extracorporeal Membrane Oxygenation

Authors

• Chetan Pasrija, Division of Cardiac Surgery, University of Maryland, School of Medicine, Baltimore, MD. Electronic address: cpasrija@gmail.com.
• Zachary N. Kon, Department of Cardiothoracic Surgery, Northwell Health, New York, NY.
• Michael A. Mazzeffi, Department of Anesthesiology and Critical Care Medicine, George Washington University School of Medicine, Washington, DC.
• Jiafeng Zhang, Division of Cardiac Surgery, University of Maryland, School of Medicine, Baltimore, MD.
• Zhongjun J. Wu, Division of Cardiac Surgery, University of Maryland, School of Medicine, Baltimore, MD.
• Douglas Tran, Division of Cardiac Surgery, University of Maryland, School of Medicine, Baltimore, MD.
• Gregory J. Bittle, Division of Cardiac Surgery, University of Maryland, School of Medicine, Baltimore, MD.
• Mehrdad Ghoreishi, Division of Cardiac Surgery, University of Maryland, School of Medicine, Baltimore, MD.
• Timothy R. Miller, Department of Radiology, Division of Neuroradiology, University of Maryland, School of Medicine, Baltimore, MD.
• Hani Alkhatib, Department of Medicine, University of Maryland, School of Medicine, Baltimore, MD.
• Nicole Tobin, Division of Cardiac Surgery, University of Maryland, School of Medicine, Baltimore, MD.
• Bradley S. Taylor, Division of Cardiac Surgery, University of Maryland, School of Medicine, Baltimore, MD.
• Kristopher B. Deatrick, Division of Cardiac Surgery, University of Maryland, School of Medicine, Baltimore, MD.
• Raymond Rector, Perfusion Services, University of Maryland Medical Center, Baltimore, MD.
• Daniel L. Herr, Program in Trauma, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD.
• Bartley P. Griffith, Division of Cardiac Surgery, University of Maryland, School of Medicine, Baltimore, MD.

Document Type

Journal Article

Publication Date

5-1-2023

Journal

Journal of cardiothoracic and vascular anesthesia

Volume

37

Issue

5

DOI

10.1053/j.jvca.2022.12.025

Keywords

ECMO complications; Extracorporeal membrane oxygenation; Spinal cord injury; Veno-arterial extracorporeal membrane oxygenation

Abstract

OBJECTIVES: There have been sporadic reports of ischemic spinal cord injury (SCI) during venoarterial extracorporeal membrane oxygenation (VA-ECMO) support. The authors observed a troubling pattern of this catastrophic complication and evaluated the potential mechanisms of SCI related to ECMO. DESIGN: This study was a case series. SETTING: This study was performed at a single institution in a University setting. PARTICIPANTS: Patients requiring prolonged VA-ECMO were included. INTERVENTIONS: No interventions were done. This was an observational study. MEASUREMENTS AND MAIN RESULTS: Four hypotheses of etiology were considered: (1) hypercoagulable state/thromboembolism, (2) regional hypoxia/hypocarbia, (3) hyperperfusion and spinal cord edema, and (4) mechanical coverage of spinal arteries. The SCI involved the lower thoracic (T7-T12 level) spinal cord to the cauda equina in all patients. Seven out of 132 (5.3%) patients with prolonged VA-ECMO support developed SCI. The median time from ECMO cannulation to SCI was 7 (range: 6-17) days.There was no evidence of embolic SCI or extended regional hypoxia or hypocarbia. A unilateral, internal iliac artery was covered by the arterial cannula in 6/7 86%) patients, but flow into the internal iliac was demonstrated on imaging in all available patients. The median total flow (ECMO + intrinsic cardiac output) was 8.5 L/min (LPM), and indexed flow was 4.1 LPM/m. The median central venous oxygen saturation was 88%, and intracranial pressure was measured at 30 mmHg in one patient, suggestive of hyperperfusion and spinal cord edema. CONCLUSIONS: An SCI is a serious complication of extended peripheral VA-ECMO support. Its etiology remains uncertain, but the authors' preliminary data suggested that spinal cord edema from hyperperfusion or venous congestion could contribute.

APA Citation

Pasrija, Chetan; Kon, Zachary N.; Mazzeffi, Michael A.; Zhang, Jiafeng; Wu, Zhongjun J.; Tran, Douglas; Bittle, Gregory J.; Ghoreishi, Mehrdad; Miller, Timothy R.; Alkhatib, Hani; Tobin, Nicole; Taylor, Bradley S.; Deatrick, Kristopher B.; Rector, Raymond; Herr, Daniel L.; and Griffith, Bartley P., "Spinal Cord Infarction With Prolonged Femoral Venoarterial Extracorporeal Membrane Oxygenation" (2023). GW Authored Works. Paper 2997.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/2997

Department

Anesthesiology and Critical Care Medicine