{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T19:19:42Z","timestamp":1740165582097,"version":"3.37.3"},"reference-count":14,"publisher":"Georg Thieme Verlag KG","issue":"04","license":[{"start":{"date-parts":[[2024,9,19]],"date-time":"2024-09-19T00:00:00Z","timestamp":1726704000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Asian J Neurosurg"],"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>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\u2009hours 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.<\/jats:p>","DOI":"10.1055\/s-0044-1791189","type":"journal-article","created":{"date-parts":[[2024,9,19]],"date-time":"2024-09-19T23:04:31Z","timestamp":1726787071000},"page":"812-815","source":"Crossref","is-referenced-by-count":0,"title":["Successful Microsurgical Clipping under Extracorporeal Membrane Oxygenation Treatment for a Poor-Grade Subarachnoid Hemorrhage Patient with Severe Pulmonary Neurogenic Lung"],"prefix":"10.1055","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5102-3080","authenticated-orcid":false,"given":"Katsuya","family":"Saito","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Saiseikai Utsunomiya Hospital, Utsunomiya, Tochigi, Japan"},{"name":"Department of Neurosurgery, Dokkyo Medical University, Shimotsugagun, Tochigi, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shoko","family":"Ito","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Saiseikai Utsunomiya Hospital, Utsunomiya, Tochigi, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takahiro","family":"Miyata","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Saiseikai Utsunomiya Hospital, Utsunomiya, Tochigi, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keita","family":"Mayanagi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Saiseikai Utsunomiya Hospital, Utsunomiya, Tochigi, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5076-2455","authenticated-orcid":false,"given":"Joji","family":"Inamasu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Saiseikai Utsunomiya Hospital, Utsunomiya, Tochigi, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masashi","family":"Nakatsukasa","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Saiseikai Utsunomiya Hospital, Utsunomiya, Tochigi, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2024,9,19]]},"reference":[{"key":"ref1","first-page":"9537453","article-title":"Successful extracorporeal membrane oxygenation (ECMO) use without systemic anticoagulation for acute respiratory distress syndrome in a patient with aneurysmal subarachnoid hemorrhage","volume":"2019","author":"A L Faulkner","year":"2019","journal-title":"Case Rep Neurol Med"},{"issue":"08","key":"ref2","doi-asserted-by":"crossref","first-page":"1389","DOI":"10.1097\/CCM.0000000000002502","article-title":"Neurologic injury in adults supported with veno-venous extracorporeal membrane oxygenation for respiratory failure: findings from the Extracorporeal Life Support 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