(203) Neurosurgical Procedures in Patients Requiring ECMO (NSPIRE)

Tuesday, January 23, 2024

12:30 PM – 1:30 PM MT

Location: Connections Central - RST 08

First Author(s)

Ryan Lee (he/him/his)

University of Maryland School of Medicine
Baltimore, MD

Co-Author(s)

SH

Samantha Helmy, N/A

Medical Student
University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
JC

Jeronimo Cardona, n/a

Medical Student
University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
DZ

David Zhao, N/A

Medical Student
Johns Hopkins University School of Medicine, Baltimore, MD, United States
RR

Raymond Rector, n/a

ECMO Program Manager
University of Maryland School of Medicine, Department of Surgery, Division of Cardiac Surgery, Baltimore, MD, United States
JR

Joseph Rabin, N/A

Associate Professor
R Adams Cowley Shock Trauma Center, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, United States
MM

Michael Mazzeffi, n/a

Professor, Medical Director TCV ICU
University of Virginia Medical Center, Department of Anesthesiology, Charlottesville, VA, United States
SC

Sung-Min Cho, n/a

Associate Professor
Johns Hopkins University School of Medicine, Neuroscience Critical Care Division, Departments of Neurology, Surgery, and Anesthesiology and Critical Care Medicine, Baltimore, MD, United States
NM

Nicholas Morris, n/a

Associate Professor
University of Maryland School of Medicine, Department of Neurology, Program in Trauma, University of Maryland Medical Center, Baltimore, MD, United States
IK

Imad Khan, N/A

Assistant Professor
University of Rochester Medical Center, Department of Neurology, Rochester, NY, United States

Introduction: Extracorporeal membrane oxygenation (ECMO) is a potentially lifesaving intervention often withheld in patients requiring acute neurosurgical intervention. Outcomes for ECMO patients requiring neurosurgery are rarely reported. Here, we present a multicenter case series of this population across 4 high-volume ECMO centers.

Methods: A retrospective chart review of adult ECMO patients from 2015-2023 who had undergone neurosurgery during or before ECMO therapy in the same hospitalization was performed independently at 4 institutions and combined for analysis. The primary outcome was survival to hospital discharge. The key secondary outcome was survival to discharge with good neurologic outcome (Cerebral Performance Category [CPC] 1-2).

Results: In total 24 patients were included, of whom 88% were male and had a mean age of 40.9 years. Indications for neurosurgical intervention included traumatic brain (n=7) or spinal (n=3) injury, spontaneous intracranial hemorrhage (n=6) and acute ischemic stroke (n=5). Neurosurgical operations performed included EVD/ICP monitor placement (n=10), craniectomy/craniotomy (n=5), endovascular thrombectomy (n=4) and spinal surgery (n=3). Neurosurgery was performed during ECMO in 11 (46%) patients while the remainder occurred prior to ECMO. Indications for ECMO included acute respiratory distress syndrome (ARDS, n= 11), cardiac arrest (n=6) and refractory shock (n=6); veno-venous and veno-arterial ECMO was performed in 12 patients each. Sequential organ failure assessment (SOFA) scores on cannulation day averaged 10.7.
Fifteen (63%) patients survived to hospital discharge, of whom 12 (80%) were discharged with favorable neurologic outcome (CPC 1 or 2). Survival to discharge was similar between those who had neurosurgical procedures performed while on ECMO (7/11, 63%) and prior to ECMO (8/13, 62%). ECMO related complications occurred in 17/24 (62.9%) patients while 3/24 (12.5%) experienced a complication related to neurosurgery. The cohort presented here had similar survival to discharge as a comparison of Extracorporeal Life Support Organization registry patients from 2018-2022 of 53.3% (elso.org/registry).

Conclusions: Carefully selected patients requiring neurosurgical intervention treated with ECMO appear to have survival outcomes comparable to other cohorts.