PDF(Pubmed)
Abstract：
BACKGROUND: Neurological complications are common in the management of venoarterial extracorporeal membrane oxygenation (VA-ECMO), with most patients requiring sedation and intubation, limiting the assessment of neurological function. There-fore, we must rely on advanced neuroimaging techniques, such as computed tomography angiography (CTA) and computed tomography perfusion (CTP). Because ECMO changes the normal blood flow pattern, it may interfere with the contrast medium in some special cases, leading to artifacts and ultimately mis-leading clinical decisions.
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.
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.
摘要：
背景：在静脉动脉体外膜氧合（VA-ECMO）的治疗中，神经系统并发症很常见，大多数患者需要镇静和插管，限制神经功能的评估。因此，我们必须依靠先进的神经成像技术，如计算机断层扫描血管造影（CTA）和计算机断层扫描灌注（CTP）。因为ECMO改变了正常的血流模式,在某些特殊情况下，它可能会干扰造影剂，导致伪影，最终导致错误的临床决策。
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。
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。
