The Use of Extracorporeal Membrane Oxygenation in Traumatic Brain Injury and Neurosurgical Patients: A Single-center Analysis

Introduction: Extracorporeal membrane oxygenation (ECMO) is a life-saving intervention typically reserved for severe respiratory or cardiac failure. However, its use is often considered contraindicated in patients with traumatic brain injury (TBI), especially those undergoing neurosurgical procedures.

Methods: We retrospectively identified all patients who presented to our institution between 2019 and 2024 with TBI and received ECMO therapy during their admission. We extracted information regarding their demographics, diagnoses, and management from the electronic medical records.

Results: 6 TBI patients received ECMO therapy. All were male with an average age of 21.17 years. The average GCS at presentation was 6.5 (range 3-14). Cerebral contusions, epidural hematomas, subdural hematomas, subarachnoid hemorrhages, and diffuse axonal injuries were observed in 66.67%, 33.33%, 50%, 50%, and 50% of patients, respectively. The median length of time between TBI and ECMO cannulation was 2.5 days (range 0-22 days). 4 patients were maintained on ECMO with no anticoagulation, whereas 2 patients were given systemic heparinization titrated to an average target aPTT of 50-70 seconds. 2 patients (both initial GCS 3 and no anticoagulation) underwent a decompressive craniectomy while on EMCO. 2 patients had a craniotomy performed an average of 5.5 days before ECMO, and 2 patients (average initial GCS 4) did not undergo any neurosurgical procedures during the peri-ECMO period. 5 of 6 patients had good neurological outcomes; there was one mortality. There were no ECMO-related hemorrhagic or thrombotic complications. The median duration of ECMO therapy was 3.5 days (range 2-21 days).

Conclusion : ECMO can be safely utilized in patients with TBI who require intensive cardiopulmonary support. In this population, especially those who have undergone or are requiring neurosurgical intervention, maintaining the circuit without anticoagulation should be considered. Despite the historical caution in using ECMO in these patients, our data suggests that favorable neurological outcomes can be achieved.