Case Report
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 16, 2024; 12(17): 3130-3137
Published online Jun 16, 2024. doi: 10.12998/wjcc.v12.i17.3130
Cerebral pseudoinfarction due to venoarterial extracorporeal membrane oxygenation: A case report
Mi Xu, Jue-Yue Yan, Jia-Jia Jin, Tong Li
Mi Xu, Jue-Yue Yan, Jia-Jia Jin, Tong Li, Department of Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
Author contributions: Xu M and Yan JY contributed to manuscript writing, editing, and data collection; Jin JJ contributed to data analysis; Li T contributed to conceptualization and supervision. All authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Tong Li, PhD, Chief Doctor, Department of Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou 310003, Zhejiang Province, China. drli@zju.edu.cn
Received: February 4, 2024
Revised: March 16, 2024
Accepted: April 22, 2024
Published online: June 16, 2024
Processing time: 121 Days and 6.9 Hours
Abstract
BACKGROUND

Neurological complications are common in the management of venoarterial extracorporeal membrane oxygenation (VA-ECMO), with most patients requiring sedation and intubation, limiting the assessment of neurological function. There-fore, we must rely on advanced neuroimaging techniques, such as computed tomography angiography (CTA) and computed tomography perfusion (CTP). Because ECMO changes the normal blood flow pattern, it may interfere with the contrast medium in some special cases, leading to artifacts and ultimately mis-leading clinical decisions.

CASE SUMMARY

A 61-year-old man presented to a local hospital with chest tightness and pain 1 d prior to presentation. The patient was treated with VA-ECMO after sudden car-diac and respiratory arrest at a local hospital. For further treatment, the patient was transferred to our hospital. The initial consciousness assessment was not clear, and routine CTP was performed to understand the intracranial changes, which suggested a large area of cerebral infarction on the right side; however, the cerebral oxygen was not consistent with the CTP results, and the reexamination of CTA still suggested a right cerebral infarction. To identify this difference, bedside transcranial Doppler was performed, and the blood flow on both sides was different. By reducing the ECMO flow, CTP reexamination showed that the results were normal and consistent with the clinical results. On day 3, the patient was alert and showed good limb movements.

CONCLUSION

In patients with peripheral VA-ECMO, cerebral perfusion confirmed by CTP and CTA may lead to false cerebral infarction.

Keywords: Extracorporeal membrane oxygenation; Computed tomography perfusion; Computed tomography angiography; Cerebral perfusion; Contrast medium artifacts; Case report

Core Tip: In venoarterial extracorporeal membrane oxygenation (VA-ECMO) patients, neurological complications are common and require sedation and tracheal intubation, limiting neurological assessment and necessitating reliance on advanced neuroimaging techniques, such as computed tomography angiography (CTA) and computed tomography perfusion (CTP). We report a rare case of VA-ECMO-induced abnormal flow patterns causing unique CTA and CTP artifacts mimicking cerebral infarction. Combined with the analysis of PubMed index cases, we found that peripheral VA-ECMO CTA and CTP may generate rare artifacts, which may mislead clinicians in diagnosing acute stroke, posing serious consequences for patients. Early detection is vital for prognosis, and noninvasive monitoring methods (transcranial Doppler, near-infrared spectroscopy, and continuous electroencephalography) can aid in identification.