PMID- 36842938
OWN - NLM
STAT- MEDLINE
DCOM- 20230404
LR  - 20230405
IS  - 1532-8422 (Electronic)
IS  - 1053-0770 (Linking)
VI  - 37
IP  - 5
DP  - 2023 May
TI  - Spinal Cord Infarction With Prolonged Femoral Venoarterial Extracorporeal 
      Membrane Oxygenation.
PG  - 758-766
LID - S1053-0770(22)00919-3 [pii]
LID - 10.1053/j.jvca.2022.12.025 [doi]
AB  - 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(2). 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.
CI  - Copyright (c) 2023 Elsevier Inc. All rights reserved.
FAU - Pasrija, Chetan
AU  - Pasrija C
AD  - Division of Cardiac Surgery, University of Maryland, School of Medicine, 
      Baltimore, MD. Electronic address: cpasrija@gmail.com.
FAU - Kon, Zachary N
AU  - Kon ZN
AD  - Department of Cardiothoracic Surgery, Northwell Health, New York, NY.
FAU - Mazzeffi, Michael A
AU  - Mazzeffi MA
AD  - Department of Anesthesiology and Critical Care Medicine, George Washington 
      University School of Medicine, Washington, DC.
FAU - Zhang, Jiafeng
AU  - Zhang J
AD  - Division of Cardiac Surgery, University of Maryland, School of Medicine, 
      Baltimore, MD.
FAU - Wu, Zhongjun J
AU  - Wu ZJ
AD  - Division of Cardiac Surgery, University of Maryland, School of Medicine, 
      Baltimore, MD.
FAU - Tran, Douglas
AU  - Tran D
AD  - Division of Cardiac Surgery, University of Maryland, School of Medicine, 
      Baltimore, MD.
FAU - Bittle, Gregory J
AU  - Bittle GJ
AD  - Division of Cardiac Surgery, University of Maryland, School of Medicine, 
      Baltimore, MD.
FAU - Ghoreishi, Mehrdad
AU  - Ghoreishi M
AD  - Division of Cardiac Surgery, University of Maryland, School of Medicine, 
      Baltimore, MD.
FAU - Miller, Timothy R
AU  - Miller TR
AD  - Department of Radiology, Division of Neuroradiology, University of Maryland, 
      School of Medicine, Baltimore, MD.
FAU - Alkhatib, Hani
AU  - Alkhatib H
AD  - Department of Medicine, University of Maryland, School of Medicine, Baltimore, 
      MD.
FAU - Tobin, Nicole
AU  - Tobin N
AD  - Division of Cardiac Surgery, University of Maryland, School of Medicine, 
      Baltimore, MD.
FAU - Taylor, Bradley S
AU  - Taylor BS
AD  - Division of Cardiac Surgery, University of Maryland, School of Medicine, 
      Baltimore, MD.
FAU - Deatrick, Kristopher B
AU  - Deatrick KB
AD  - Division of Cardiac Surgery, University of Maryland, School of Medicine, 
      Baltimore, MD.
FAU - Rector, Raymond
AU  - Rector R
AD  - Perfusion Services, University of Maryland Medical Center, Baltimore, MD.
FAU - Herr, Daniel L
AU  - Herr DL
AD  - Program in Trauma, R Adams Cowley Shock Trauma Center, University of Maryland 
      School of Medicine, Baltimore, MD.
FAU - Griffith, Bartley P
AU  - Griffith BP
AD  - Division of Cardiac Surgery, University of Maryland, School of Medicine, 
      Baltimore, MD.
LA  - eng
PT  - Journal Article
PT  - Observational Study
DEP - 20230105
PL  - United States
TA  - J Cardiothorac Vasc Anesth
JT  - Journal of cardiothoracic and vascular anesthesia
JID - 9110208
SB  - IM
MH  - Humans
MH  - *Extracorporeal Membrane Oxygenation/adverse effects/methods
MH  - *Spinal Cord Injuries/diagnostic imaging/etiology/therapy
MH  - *Spinal Cord Ischemia/diagnostic imaging/etiology
MH  - Hypoxia/etiology/therapy
MH  - Infarction
MH  - Retrospective Studies
OTO - NOTNLM
OT  - ECMO complications
OT  - Extracorporeal membrane oxygenation
OT  - Spinal cord injury
OT  - Veno-arterial extracorporeal membrane oxygenation
COIS- Conflict of Interest C. Pasrija, Z. N. Kon, B. P. Griffith, M. Ghoreishi, and 
      G.J. Bittle have a patent pending for an ECMO cannula. B. P. Griffith & D.L. Herr 
      receives consultant fees for an ECMO system.
EDAT- 2023/02/27 06:00
MHDA- 2023/04/04 06:42
CRDT- 2023/02/26 22:10
PHST- 2022/05/28 00:00 [received]
PHST- 2022/12/06 00:00 [revised]
PHST- 2022/12/23 00:00 [accepted]
PHST- 2023/04/04 06:42 [medline]
PHST- 2023/02/27 06:00 [pubmed]
PHST- 2023/02/26 22:10 [entrez]
AID - S1053-0770(22)00919-3 [pii]
AID - 10.1053/j.jvca.2022.12.025 [doi]
PST - ppublish
SO  - J Cardiothorac Vasc Anesth. 2023 May;37(5):758-766. doi: 
      10.1053/j.jvca.2022.12.025. Epub 2023 Jan 5.