Spinal cord ischemia in patients on venoarterial extracorporeal membrane oxygenation: a literature review.

BACKGROUND AND OBJECTIVE: Several cases of spinal cord ischemia (SCI) on venoarterial extracorporeal membrane oxygenation (VA ECMO) support have been reported recently. We perform a review of the literature regarding this devastating complication with the goal of better understanding the relative distribution of these potential mechanisms and prognosis.

METHODS: A comprehensive search of the PubMed (MEDLINE) database for all articles in English language describing cases of SCI on VA ECMO support was performed. No time limits were placed. Reference lists of all reviewed articles were similarly searched for potential relevance. Case reports and case series were included.

KEY CONTENT AND FINDINGS: There were 13 reports with a total of 33 patients suffering from SCI on VA ECMO support with an overall incidence of 0.3-3%. Reported risk factors for SCI on VA ECMO support included spinal cord hypoperfusion and vasospasm, thromboembolism from the ECMO circuit, disruption of aortic wall thrombus or dissection from prior cardiac catheterization, aortic occlusion from intra-aortic balloon pump (IABP) use, and stasis in the descending aorta from the watershed phenomenon. Twenty-eight (85%) had magnetic resonance imaging confirmation. Fifteen (68%) survived to discharge and 1 (8%) showed some neurologic recovery.

CONCLUSIONS: Several potential etiologic factors have been proposed for SCI on VA ECMO support. Potential solutions are broad and include visualization and manipulation of the mixing zone through creation of an artificial pulse on the ECMO circuit. Further research is needed.