Rangappa Rajavardhan, Deshpande Raghavendra, Teja Eswara Sree Pradeep, Moola Narayana Swamy, Itagi Soumya
Manipal Hospitals Sarjapur Road, Bengaluru, 560102 India.
Indian J Thorac Cardiovasc Surg. 2024 Jul;40(4):469-472. doi: 10.1007/s12055-023-01672-8. Epub 2024 Jan 5.
Extracorporeal membrane oxygenation (ECMO) plays a crucial role in managing heart and respiratory failure. However, it is associated with complications such as bleeding, acute renal failure, neurological issues, and thrombosis. Cerebral venous sinuses thrombosis (CVST) is a rare condition that primarily affects young females, especially those of childbearing age. CVST can result from multiple factors, both congenital and acquired, such as pregnancy, dehydration, oral contraceptives, and the postpartum period. The most common and nonspecific symptom is headache. Notably, the occurrence of CVST during ECMO has not been documented in adult patients. In this case report, we present the case of a 29-year-old lactating mother who was admitted to our hospital with complaints and clinical features indicative of community-acquired pneumonia. Despite conventional treatment, her oxygen requirement increased; therefore, she was placed on veno-venous ECMO (VV ECMO). Her condition gradually improved, and she was extubated while still on ECMO support (Awake ECMO). However, a day later of successful weaning from ECMO, she reported blurred vision and proptosis. Magnetic resonance imaging (MRI) and MR venography (MRV) of the brain showed features suggestive of CVST. She was promptly treated with anticoagulation and later discharged with minimal residual complications. This paper emphasizes the importance of early clinical recognition and treatment with anticoagulants in cases of CVST during ECMO for improved outcomes.
体外膜肺氧合(ECMO)在治疗心脏和呼吸衰竭方面发挥着关键作用。然而,它会引发诸如出血、急性肾衰竭、神经问题和血栓形成等并发症。脑静脉窦血栓形成(CVST)是一种罕见病症,主要影响年轻女性,尤其是育龄女性。CVST可由多种先天性和后天性因素引起,如妊娠、脱水、口服避孕药以及产后阶段。最常见且无特异性的症状是头痛。值得注意的是,成人患者在ECMO期间发生CVST的情况尚无文献记载。在本病例报告中,我们呈现了一名29岁哺乳期母亲的病例,她因出现提示社区获得性肺炎的症状和临床特征而入住我院。尽管接受了常规治疗,她的氧气需求仍增加;因此,她接受了静脉 - 静脉ECMO(VV ECMO)治疗。她的病情逐渐改善,在仍接受ECMO支持时(清醒ECMO)拔管。然而,在成功脱离ECMO一天后,她报告出现视力模糊和眼球突出。脑部磁共振成像(MRI)和磁共振静脉造影(MRV)显示有提示CVST的特征。她立即接受了抗凝治疗,后来出院时遗留的并发症极少。本文强调了在ECMO期间CVST病例中早期临床识别和抗凝治疗对于改善预后的重要性。