title: Veno-arterial extracorporeal membrane oxygenation support for severe cardiac failure in a pediatric patient with intracranial hemorrhage after spontaneous aneurysmatic rupture.
abstract: BACKGROUND
  Extracorporeal life support in adult patients with extended intracranial hemorrhage is controversial. In pediatric patients, it has traditionally been considered a contraindication as systemic anticoagulation may worsen the hemorrhage and neurological outcome.
  
  
  METHODS
  We present a nine-year-old female patient who was admitted with extended intracranial hemorrhage after spontaneous rupture of an aneurysm. On day four after the emergency craniotomy, she required veno-arterial extracorporeal membrane oxygenation for septic shock. Using an adapted anticoagulation protocol aimed at lower activated partial thromboplastin time target values, we did not observe any new bleeding or clotting complications during systemic anticoagulation and the patient had good neurological recovery.
  
  
  CONCLUSIONS
  Extracorporeal life support with low dose systemic anticoagulation can be considered as a treatment option in pediatric patients after craniotomy for intracranial aneurysmatic hemorrhage.
authors.affiliation: KUNO University Children's Hospital Regensburg, Germany robert.zant@ukr.de.
authors.forename: Robert
authors.initials: R
authors.lastname: Zant
authors.affiliation: KUNO University Children's Hospital Regensburg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Melter
authors.affiliation: KUNO University Children's Hospital Regensburg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Doerfler
authors.affiliation: KUNO University Children's Hospital Regensburg, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Gerling
authors.affiliation: Department of Cardiothoracic Surgery, University Medical Center Regensburg, Germany.
authors.forename: Leopold
authors.initials: L
authors.lastname: Rupprecht
authors.affiliation: Department of Cardiothoracic Surgery, University Medical Center Regensburg, Germany.
authors.forename: Alois
authors.initials: A
authors.lastname: Philipp
authors.affiliation: KUNO University Children's Hospital Regensburg, Germany.
authors.forename: Juergen
authors.initials: J
authors.lastname: Kunkel
mesh_terms: D017542:Aneurysm, Ruptured / Q000150:complications / Q000628:therapy; D002648:Child; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000628:therapy; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000628:therapy; D020300:Intracranial Hemorrhages / Q000209:etiology / Q000628:therapy; D012720:Severity of Illness Index
keywords: ECMO; extracorporeal membrane oxygenation; intracranial bleed