Extracorporeal membrane oxygenation-related spinal cord infarction: a case report

Abstract Extracorporeal membrane oxygenation (ECMO) is a high-risk extracorporeal technique that serves as an effective last-ditch salvage therapy for patients with severe heart or respiratory failure. The most common complications observed after ECMO include hypoxic and vascular lesions (ischemic or hemorrhagic). Neurologic complications contribute to a proportion of post-treatment morbidity and mortality but have seldom been well described. We present a 26-year-old man who experienced sudden onset paraplegia after undergoing ECMO. A magnetic resonance imaging (MRI) scan revealed a spinal infarction at the T9 to L1 level, likely involving the artery of Adamkiewicz. This may be attributed to spinal hypoperfusion or thromboembolism. Similar previously reported cases show a large variation in the duration of extracorporeal membrane oxygenation; however, the venoarterial mode of ECMO was commonly used in cases with this complication. Although spinal infarction is rarely reported to occur in clinical practice after ECMO complications, it requires a high index of suspicion for recognition. Close monitoring of coagulation and platelet count and electrophysiological recording during ECMO may be useful for early detection and prevention of complications.