title: Extracorporeal membrane oxygenation for cardiac arrest during moyamoya cerebral revascularization surgery: case report.
abstract: The authors describe the case of a 51-year-old man with bilateral moyamoya disease and prior strokes who developed an asystolic cardiac arrest while undergoing revascularization surgery under mild hypothermia. The patient was successfully treated with venoarterial (VA) extracorporeal membrane oxygenation (ECMO) after manual cardiopulmonary resuscitation (CPR) was unsuccessful for 45 minutes. ECMO is a cardiopulmonary support system that is indicated for respiratory failure in pediatric and adult patients. It is increasingly being used as an extension to mechanical CPR for patients who have suffered cardiac arrest if the underlying cause of cardiac arrest is thought to be reversible. Identifying which patients should be placed on emergency ECMO after cardiac arrest is controversial given its high morbidity and mortality. ECMO in neurosurgical settings has associated risks of intracranial hemorrhage and neurological compromise, while resource utilization is paramount given the high costs of this treatment. This paper is significant because it describes the use of ECMO in an unindicated setting. Limited data are available for ECMO usage after cardiac arrest with baseline cerebral ischemia. Furthermore, this paper raises important considerations for extracorporeal CPR use in a patient who had recently undergone craniotomy. The patient in this report remained on ECMO for 48 hours, after which he was successfully weaned. He developed a pericardial effusion and compartment syndrome from the ECMO but made a complete neurological recovery. Use of ECMO emergently in an appropriately chosen neurosurgical patient is safe, even in the setting of baseline cerebral ischemia and recent craniotomy.
authors.affiliation: Department of Neurosurgery and Stanford Stroke Center, and.
authors.forename: Omar
authors.initials: O
authors.lastname: Choudhri
authors.affiliation: Department of Neurosurgery and Stanford Stroke Center, and.
authors.forename: Aatman
authors.initials: A
authors.lastname: Shah
authors.affiliation: Department of Anesthesiology, Stanford University School of Medicine, Stanford California.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Basarab-Tung
authors.affiliation: Department of Neurosurgery and Stanford Stroke Center, and.|Department of Anesthesiology, Stanford University School of Medicine, Stanford California.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Jaffe
authors.affiliation: Department of Neurosurgery and Stanford Stroke Center, and.
authors.forename: Gary K
authors.initials: GK
authors.lastname: Steinberg
mesh_terms: D002548:Cerebral Revascularization / Q000009:adverse effects* / Q000379:methods; D015199:Extracorporeal Membrane Oxygenation; D006323:Heart Arrest / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009072:Moyamoya Disease / Q000601:surgery*; D016896:Treatment Outcome
keywords: CPR = cardiopulmonary resuscitation; EC-IC = extracranial-to-intracranial; ECMO; ECMO = extracorporeal membrane oxygenation; ECPR = extracorporeal CPR; MMD = moyamoya disease; VA = venoarterial; VV = veno-venous; cardiac arrest; cerebral revascularization; hypothermia; vascular disorders