Bain Eric, Rao Roopa, Guglin Maya
Indiana University School of Medicine, Department of Internal Medicine, Indianapolis, IN.
Indiana University School of Medicine, Department of Internal Medicine, Indianapolis, IN.
J Cardiothorac Vasc Anesth. 2025 Feb;39(2):526-531. doi: 10.1053/j.jvca.2024.10.041. Epub 2024 Nov 8.
Spinal cord infarction (SCI) or ischemia is a rare but devastating complication of venoarterial extracorporeal membrane oxygenation (VA ECMO). The natural course and outcomes are poorly studied.
We completed a literature review on ischemic spinal cord injury in patients on VA ECMO and analyzed the published case reports and case series with individual patient characteristics. We also added 3 previously unpublished cases from our own experience.
The final sample included 30 adult patients on VA ECMO for cardiogenic shock secondary to various etiologies. The mean age was 47.7 ± 17.8 years with equal distribution between men and woman. The total duration on ECMO ranged from 3 to 47 days with a median of 10 days. In all patients, ECMO was placed peripherally via an arterial cannula in the femoral artery. All 30 patients developed either paraplegia (27/90%) or weakness (3/10%) of both lower extremities. Magnetic resonance imaging of the spine was consistent with infarction in 88.5% and ischemia in the rest. On follow-up, there were no cases of complete recovery. Partial recovery with significant limitations of mobility was noted in half of them. The remaining half had no signs of neurological recovery. Survival to discharge was reported in 24 cases. Of these cases, 17/70.8% survived and 7/29.2% died.
Spinal infarction/ischemia on VA ECMO typically presents with paraplegia of lower extremities with low potential for even partial recovery. Because no treatment is currently available, the efforts should be focused on prevention. Several strategies have been proposed, but they need further testing under controlled settings.
脊髓梗死（SCI）或缺血是静脉-动脉体外膜肺氧合（VA ECMO）一种罕见但具有毁灭性的并发症。其自然病程和预后研究较少。
我们完成了一项关于VA ECMO患者缺血性脊髓损伤的文献综述，并分析了已发表的病例报告和病例系列以及个体患者特征。我们还补充了3例来自我们自身经验的此前未发表的病例。
最终样本包括30例因各种病因导致心源性休克而接受VA ECMO治疗的成年患者。平均年龄为47.7±17.8岁，男女分布均衡。ECMO总使用时间为3至47天，中位数为10天。所有患者均通过股动脉的动脉插管在外周置入ECMO。所有30例患者均出现双下肢截瘫（27例/90%）或无力（3例/10%）。脊柱磁共振成像显示88.5%与梗死相符，其余为缺血。随访时，无完全恢复的病例。其中一半患者有部分恢复，但活动能力有明显限制。其余一半患者无神经恢复迹象。24例患者存活至出院。在这些病例中，17例（70.8%）存活，7例（29.2%）死亡。
VA ECMO相关的脊髓梗死/缺血通常表现为下肢截瘫，即使部分恢复的可能性也很低。由于目前尚无治疗方法，应将努力重点放在预防上。已经提出了几种策略，但需要在可控环境下进一步测试。
