Neurosurgical Procedures in Patients Requiring Extracorporeal Membrane Oxygenation.

Q4 Medicine
Critical care explorations Pub Date : 2024-10-21 eCollection Date: 2024-10-01 DOI:10.1097/CCE.0000000000001166
Ryan Lee, Samantha Helmy, Jeronimo Cardona, David Zhao, Raymond Rector, Joseph Rabin, Michael Mazzeffi, Sung-Min Cho, Gunjan Parikh, Nicholas A Morris, Imad Khan
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引用次数: 0

Abstract

Objectives: Extracorporeal membrane oxygenation (ECMO) is often withheld in patients with significant neurologic injury or recent neurosurgical intervention due to perceived futility. Studies of neurosurgical interventions before or during ECMO are limited to case reports or single-center series, limiting generalizability, and outcomes in this population are unknown. We therefore sought to report the outcomes of ECMO patients with acute neurosurgical interventions at four high-volume ECMO and comprehensive stroke centers.

Design: Retrospective case series.

Setting: Four academic tertiary referral hospitals in the United States.

Patients: Adults (n = 24) having undergone neurosurgical procedures before or during ECMO.

Interventions: None.

Measurements and main results: We retrospectively reviewed adults at four institutions who had undergone neurosurgical procedures immediately before or during ECMO from 2015 to 2023. The primary outcome was survival to hospital discharge. Secondary outcomes included favorable neurologic outcome (Cerebral Performance Category 1 or 2) and neurosurgical complications. Twenty-four of 2957 ECMO patients (0.8%) were included. Primary indications for neurosurgical intervention included traumatic brain (n = 8) or spinal (n = 3) injury, spontaneous intracranial hemorrhage (n = 6), and acute ischemic stroke (n = 5). Procedures included extraventricular drain (EVD) and/or intracranial pressure monitor placement (n = 10), craniectomy/craniotomy (n = 5), endovascular thrombectomy (n = 4), and spinal surgery (n = 3). Fifteen patients (63%) survived to hospital discharge, of whom 12 (80%) were discharged with favorable neurologic outcomes. Survival to discharge was similar for venoarterial and venovenous ECMO patients (8/12 vs. 7/12; p = 0.67) and those who had neurosurgery before vs. during ECMO (8/13 vs. 7/11; p = 0.92). One patient (4%) experienced a neurosurgical complication, a nonlethal tract hemorrhage from EVD placement. Survival to discharge was similar for neurosurgical and nonneurosurgical ECMO patients at participating institutions (63% vs. 57%; p = 0.58).

Conclusions: Patients with acute neurologic injury can feasibly undergo neurosurgery during ECMO or can undergo ECMO after recent neurosurgery. Larger studies are needed to fully understand risks for bleeding and other procedure-related complications.

需要体外膜氧合患者的神经外科手术。
目的:体外膜肺氧合(ECMO)通常被认为是徒劳的,因此在有严重神经损伤或近期接受过神经外科干预的患者中暂不使用。有关 ECMO 前或 ECMO 期间神经外科干预的研究仅限于病例报告或单中心系列研究,这限制了研究的普遍性,而且这类人群的治疗效果也不得而知。因此,我们试图报告在四家高容量 ECMO 和综合卒中中心接受急性神经外科干预的 ECMO 患者的预后:设计:回顾性病例系列:美国四家学术性三级转诊医院:干预措施:无:无干预措施:我们回顾性研究了 2015 年至 2023 年期间在四家医疗机构接受过神经外科手术的成人,这些成人在 ECMO 之前或期间接受过神经外科手术。主要结果是出院后的存活率。次要结果包括良好的神经功能结果(脑功能 1 类或 2 类)和神经外科并发症。2957 例 ECMO 患者中有 24 例(0.8%)入选。神经外科干预的主要适应症包括创伤性脑损伤(8 例)或脊柱损伤(3 例)、自发性颅内出血(6 例)和急性缺血性中风(5 例)。手术包括脑室外引流管(EVD)和/或颅内压监护仪置入(10 例)、颅骨切除术/开颅术(5 例)、血管内血栓切除术(4 例)和脊柱手术(3 例)。15名患者(63%)存活出院,其中12名患者(80%)出院时神经功能状况良好。静脉和静脉 ECMO 患者的出院存活率相似(8/12 对 7/12;P = 0.67),在 ECMO 之前和 ECMO 期间接受神经外科手术的患者的出院存活率相似(8/13 对 7/11;P = 0.92)。一名患者(4%)出现了神经外科并发症,即 EVD 置入引起的非致命性道出血。在参与机构中,神经外科和非神经外科 ECMO 患者的出院存活率相似(63% vs. 57%; p = 0.58):结论:急性神经损伤患者可在 ECMO 期间接受神经外科手术,或在近期接受神经外科手术后接受 ECMO。需要进行更大规模的研究,以充分了解出血和其他手术相关并发症的风险。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
5.70
自引率
0.00%
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0
审稿时长
8 weeks
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