体外膜肺氧合相关颅内出血开颅术后的神经结局：病例系列及文献复习。
Neurological Outcomes Following Craniotomy for Extracorporeal Membrane Oxygenation-Associated Intracranial Hemorrhage: Case Series and Literature Review.
机构信息
Department of Neurological Surgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA.
Department of Neurological Surgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA.
出版信息
World Neurosurg. 2024 Oct;190:e478-e487. doi: 10.1016/j.wneu.2024.07.160. Epub 2024 Jul 27.
BACKGROUND
Intracranial hemorrhage (ICH) is a potential complication associated with extracorporeal membrane oxygenation (ECMO), which has been increasingly utilized in recent years. A paucity of data exists describing patient outcomes following invasive neurosurgical interventions in patients receiving ECMO therapy. The purpose of this study was to assess the clinical and functional outcomes in patients who underwent cranial neurosurgery for the management of an ECMO-associated intracranial complication.
METHODS
This was a single-institution retrospective review of adult patients who underwent craniotomy or craniectomy after sustaining an intracranial hemorrhagic complication of ECMO therapy from 2008 to 2023. Anticoagulation status, operative indication, surgical details, postoperative course, and functional outcome were recorded. A systematic review of the prior literature was performed to contextualize our institutional results within previous reports.
RESULTS
Four adult patients were identified at our institution who underwent craniotomy or craniectomy for the neurosurgical management of an ECMO-associated ICH. One patient (25%) ultimately made a satisfactory recovery (Modified Rankin Scale score 3 at 1 year). The surviving patient had a notably higher Glasgow Coma Scale (7T vs. 3T), had not received anticoagulation at the time of surgery, and did not experience postoperative reaccumulation or expansion of their hemorrhage, distinguishing factors from the other 3 included. Review of the existing literature identified 15 adult patients who underwent craniotomy while receiving ECMO therapy, of which 4 (26.7%) had a long-term favorable neurologic outcome.
CONCLUSIONS
The overall prognosis following neurosurgical intervention for the management of ECMO-associated intracranial complications was poor in our case series, which was corroborated by our literature review.
背景
颅内出血（ICH）是体外膜肺氧合（ECMO）相关的潜在并发症，近年来其应用日益增多。目前描述接受 ECMO 治疗的患者接受侵入性神经外科干预后结局的数据有限。本研究的目的是评估因 ECMO 相关颅内并发症而行颅神经外科手术的患者的临床和功能结局。
方法
这是一项对 2008 年至 2023 年期间因 ECMO 治疗相关颅内出血并发症而行开颅或颅骨切除术的成年患者进行的单中心回顾性研究。记录抗凝状态、手术指征、手术细节、术后过程和功能结局。对先前文献进行系统回顾，以使我们的机构结果与先前报告的结果相适应。
结果
在我们的机构中，有 4 名成年患者因 ECMO 相关 ICH 的神经外科治疗而行开颅或颅骨切除术。1 名患者（25%）最终恢复良好（1 年时改良 Rankin 量表评分为 3 分）。存活患者的格拉斯哥昏迷量表评分明显更高（7T 比 3T），手术时未接受抗凝治疗，且术后未发生出血再积聚或扩大，与其他 3 例患者有区别。对现有文献的回顾确定了 15 名在接受 ECMO 治疗期间行开颅手术的成年患者，其中 4 名（26.7%）有长期良好的神经结局。
结论
在我们的病例系列中，接受 ECMO 相关颅内并发症治疗的神经外科干预后的总体预后较差，我们的文献复习也证实了这一点。
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