Complications neurologiques sous ECMO : éviter le pire

Abstract

ECMO, an acronym for extracorporeal membrane oxygenation, is a recent emergency technique for short-term circulatory and/or pulmonary assistance used in cases of dysfunction refractory to conventional treatment and care.

This type of assistance intrinsically involves major risks and complications for the patient receiving it. Its implementation is therefore based on the consideration of the benefit-risk ratio. The ideal timing for implantation remains difficult to determine. Future studies will certainly provide more information on this subject.

The complications associated with this technique are multifactorial and frequent. They can be : 

• Occur as soon as the procedure is performed: vascular dissection during cannulation 
• Be linked to :
  • A mechanical dysfunction (of the membrane, of the centrifugal pump), to the circuit (thrombosis of the circuit, gas embolism) 
  • Mobilization : accidental decanulation
  • Non-mechanical causes : infectious, ischemic, hemorrhagic, hematological, neurological...

This review focuses on neurological complications related to ECMO.