TY - JOUR
T1 - Managing medically refractory elevated intracranial pressure in a pediatric patient on ECMO
T2 - illustrative case
AU - Young, Tirone
AU - Ezzat, Bahie
AU - Nichols, Noah
AU - Aydin, Scott
AU - Pastuszko, Peter
AU - Morgenstern, Peter F.
N1 - Publisher Copyright:
© The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2024.
PY - 2024/11
Y1 - 2024/11
N2 - 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.
AB - 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.
KW - Anticoagulation management
KW - Congenital heart disease
KW - Craniectomy
KW - ECMO
UR - http://www.scopus.com/inward/record.url?scp=85199471308&partnerID=8YFLogxK
U2 - 10.1007/s00381-024-06549-8
DO - 10.1007/s00381-024-06549-8
M3 - Article
C2 - 39046474
AN - SCOPUS:85199471308
SN - 0256-7040
VL - 40
SP - 3843
EP - 3847
JO - Child's Nervous System
JF - Child's Nervous System
IS - 11
ER -