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CC BY-NC-ND 4.0 · Asian J Neurosurg 2024; 19(04): 812-815
DOI: 10.1055/s-0044-1791189
Case Report

Successful Microsurgical Clipping under Extracorporeal Membrane Oxygenation Treatment for a Poor-Grade Subarachnoid Hemorrhage Patient with Severe Pulmonary Neurogenic Lung

Authors

  • Katsuya Saito 

    1   Department of Neurosurgery, Saiseikai Utsunomiya Hospital, Utsunomiya, Tochigi, Japan
    2   Department of Neurosurgery, Dokkyo Medical University, Shimotsugagun, Tochigi, Japan

  • Shoko Ito

    1   Department of Neurosurgery, Saiseikai Utsunomiya Hospital, Utsunomiya, Tochigi, Japan

  • Takahiro Miyata

    1   Department of Neurosurgery, Saiseikai Utsunomiya Hospital, Utsunomiya, Tochigi, Japan

  • Keita Mayanagi

    1   Department of Neurosurgery, Saiseikai Utsunomiya Hospital, Utsunomiya, Tochigi, Japan

  • Joji Inamasu 

    1   Department of Neurosurgery, Saiseikai Utsunomiya Hospital, Utsunomiya, Tochigi, Japan

  • Masashi Nakatsukasa

    1   Department of Neurosurgery, Saiseikai Utsunomiya Hospital, Utsunomiya, Tochigi, Japan

Funding None.
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Abstract

Hemorrhagic strokes are considered as contraindications of extracorporeal membrane oxygenation (ECMO) therapy because of anticoagulant administration and ECMO-associated coagulopathy. We present a rare case of successful microsurgical clipping under ECMO for a poor-grade subarachnoid hemorrhage (SAH) patient with severe neurogenic pulmonary edema (NPE). A 50-year-old man presenting with the sudden loss of consciousness was diagnosed with poor-grade SAH with severe NPE, and was intubated. Because of severe hypoxemia refractory to conventional treatment, venovenous ECMO was used 6 hours after admission. To avoid thrombosis inside the ECMO circuit despite no anticoagulants, a heparin-bonded ECMO was maintained at a comparatively high blood flow rate. Subsequently, the patient underwent a microsurgical clipping under ECMO. Intraoperatively we had difficulty in bleeding control, and therefore the multiple transfusions were necessary to correct anemia and ECMO-associated coagulopathy. The aneurysmal clipping was accomplished without hemorrhagic intracranial complications. After 2 years from onset, his activities of daily life were independent. To our knowledge, this is the first report of successful microsurgical clipping for poor-grade SAH under ECMO without any anticoagulants. The use of a heparin-bonded ECMO tubing, maintenance of a slightly higher ECMO pump speed, and multiple transfusions to correct ECMO-associated coagulopathy could make the micro-neurosurgical procedures under ECMO possible. This report demonstrated the possibility to extend the range of application of microsurgical clipping for poor-grade SAH patients requiring ECMO treatment.

Keywords

ECMO-associated coagulopathy - extracorporeal membrane oxygenation - heparin-free ECMO - microsurgical aneurysmal clipping - pulmonary neurogenic lung - subarachnoid hemorrhage

Authors' Contributions

K.S. was responsible for conceptualization, formal analysis, project administration, visualization, writing the original draft, writing, review, and editing of manuscript. Data curation was done by K.S. and S.I. Methodology was developed by K.S., T.M., K.M., J.I., and M.N.




Publication History

Article published online:
19 September 2024

© 2024. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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