Treatments of intracranial hemorrhage after extracorporeal membrane oxygenation: case report and literature review

Objective To explore the diagnosis, treatment and prognosis of intracranial hemorrhage after extracorporeal membrane oxygenation (ECMO) in children. Methods Retrospective analysis was performed for 89 ECMO cases with intracranial hemorrhage from 2011 to 2018. Their clinical data were collected and analyzed.Six children (6.7%) had intracranial hemorrhage during ECMO treatment. Among 6 cases of intracranial hemorrhage, there were 4 boys and 2 girls with an age range from 1 day to 11 years. The causes were myocarditis (n=1) and severe pneumonia (n=5). Two cases required ECMO out-hospital catheterization. The average ECMO duration was 126.8(28.0-229.5) hours. Results Computed tomography was examined for unequal pupils (n=2), magnetic resonance imaging (MRI) for hemiplegia (n=1), B-mode ultrasound for routine uses (n=2) and MRI for intracranial hemorrhage (n=1). The locations of lesion were subdural (n=1), deep brain tissue (n=1) and brain lobe (n=4). The interventions were surgery (n=2), conservative measures (n=2) and death after giving up treatments (n=2). GOS score of surgical children was 5 points (epidural hemorrhage) and 4 points (hemiparesis). Conclusions Intracranial hemorrhage is a severe hemorrhagic complication after ECMO. Early diagnosis and surgical treatment may improve its prognosis. Key words: Intracranial hemorrhages; Extracorporeal membrane oxygenation; Surgical treatment