METHODS: A 61-year-old man presented to a local hospital with chest tightness and pain 1 d prior to presentation. The patient was treated with VA-ECMO after sudden car-diac and respiratory arrest at a local hospital. For further treatment, the patient was transferred to our hospital. The initial consciousness assessment was not clear, and routine CTP was performed to understand the intracranial changes, which suggested a large area of cerebral infarction on the right side; however, the cerebral oxygen was not consistent with the CTP results, and the reexamination of CTA still suggested a right cerebral infarction. To identify this difference, bedside transcranial Doppler was performed, and the blood flow on both sides was different. By reducing the ECMO flow, CTP reexamination showed that the results were normal and consistent with the clinical results. On day 3, the patient was alert and showed good limb movements.
CONCLUSIONS: In patients with peripheral VA-ECMO, cerebral perfusion confirmed by CTP and CTA may lead to false cerebral infarction.
方法:一名61岁男子在就诊前1天因胸闷和疼痛被送往当地医院就诊。在当地医院突然发生车祸和呼吸骤停后,患者接受了VA-ECMO治疗。为了进一步治疗,病人被转到我们医院。最初的意识评估不清楚,进行常规CTP以了解颅内变化,这表明右侧有大面积的脑梗塞;然而,脑氧与CTP结果不一致,CTA复查仍提示右侧脑梗死。为了识别这种差异,进行床边经颅多普勒,两侧的血流不同。通过减少ECMO流量,CTP复查结果正常,与临床结果一致。在第3天,患者表现出警觉并表现出良好的肢体运动。
结论:在外周VA-ECMO患者中,CTP和CTA证实的脑灌注可能导致假性脑梗死。