Gu Byung Mo, Lee Hong Kyu, Ha Sang Ook, Park Sunghoon, Lee Sun Hee, Kim Hyoung Soo
Department of Thoracic and Cardiovascular Surgery, Hallym University Sacred Heart Hospital, Hallym University Medical Center, Anyang, Korea.
Department of Emergency Medicine, Hallym University Sacred Heart Hospital, Hallym University Medical Center, Anyang, Korea.
J Korean Med Sci. 2025 Sep 15;40(36):e233. doi: 10.3346/jkms.2025.40.e233.
Patients undergoing extracorporeal membrane oxygenation are at a high risk of developing intracranial hemorrhage as a neurological complication. Consequently, many physicians consider a history of intracranial hemorrhage as a relative contraindication for extracorporeal membrane oxygenation and are hesitant to use it in these patients, even in cases of acute severe heart or lung failure. This study aimed to examine the clinical outcomes of extracorporeal membrane oxygenation use in patients with intracranial hemorrhage.
We retrospectively obtained the medical records of patients diagnosed with intracranial hemorrhage who received extracorporeal membrane oxygenation owing to acute cardiopulmonary failure between January 2011 and July 2020. Data pertaining to patients' characteristics and clinical outcomes were collected. Disseminated intravascular coagulation score and extracorporeal membrane oxygenation score before and after application of extracorporeal membrane oxygenation were also examined to observe trends.
Eighteen patients were included. Ten had traumatic intracranial hemorrhage, and the most common indication for extracorporeal membrane oxygenation was acute respiratory distress syndrome. The 30-day survival rate was 72% (13 patients), and 61% (11 patients) survived to discharge. Two patients underwent neurosurgery due to worsening of intracranial hemorrhage. However, both were discharged without neurological deterioration.
A 72% survival rate was observed in extracorporeal membrane oxygenation patients with intracranial hemorrhage, suggesting that extracorporeal membrane oxygenation could be a viable option in patients with intracranial hemorrhage unresponsive to conventional therapy.
接受体外膜肺氧合治疗的患者发生颅内出血这一神经并发症的风险很高。因此，许多医生将颅内出血病史视为体外膜肺氧合的相对禁忌证，即使在急性严重心或肺衰竭的情况下，也不愿在这些患者中使用该治疗方法。本研究旨在探讨颅内出血患者使用体外膜肺氧合的临床结局。
我们回顾性获取了2011年1月至2020年7月期间因急性心肺衰竭接受体外膜肺氧合治疗的颅内出血患者的病历。收集了患者的特征和临床结局相关数据。还检查了体外膜肺氧合应用前后的弥散性血管内凝血评分和体外膜肺氧合评分，以观察其变化趋势。
共纳入18例患者。10例为创伤性颅内出血，体外膜肺氧合最常见的适应证是急性呼吸窘迫综合征。30天生存率为72%（13例患者），61%（11例患者）存活至出院。2例患者因颅内出血恶化接受了神经外科手术。然而，两人均出院时无神经功能恶化。
颅内出血患者接受体外膜肺氧合治疗的生存率为72%，这表明对于对传统治疗无反应的颅内出血患者，体外膜肺氧合可能是一种可行的选择。
