Managing medically refractory elevated intracranial pressure in a pediatric patient on ECMO: illustrative case

Tirone Young, Bahie Ezzat, Noah Nichols, Scott Aydin, Peter Pastuszko, Peter F. Morgenstern

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: We demonstrate the complexities of managing pediatric patients on extracorporeal membrane oxygenation (ECMO) therapy requiring neurosurgery, focusing on systemic anticoagulation, cardiac function, and medically refractory intracranial pressure (ICP). Methods: A 3.5-year-old female with Tetralogy of Fallot developed severe ischemic cerebral edema following post-operative cardiac arrest and required ECMO. This case, along with four additional cases of children requiring neurosurgery while on ECMO, was examined. Results: Emergency neurosurgical intervention in the primary case led to significant improvement, highlighting the delicate balance between managing ECMO-induced anticoagulation and urgent neurosurgical needs. The additional cases had variable outcomes, emphasizing the challenges of caring for these critically ill patients. Conclusion: Successful management of children requiring ECMO support and neurosurgical intervention requires thoughtful multidisciplinary care. This report illustrates some of the nuances in such decision-making, and demonstrates one potential path to a good outcome.

Original languageEnglish
Pages (from-to)3843-3847
Number of pages5
JournalChild's Nervous System
Volume40
Issue number11
DOIs
StatePublished - Nov 2024

Keywords

  • Anticoagulation management
  • Congenital heart disease
  • Craniectomy
  • ECMO

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