{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T04:23:39Z","timestamp":1791347019118,"version":"4.3.1"},"reference-count":11,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","license":[{"start":{"date-parts":[[2024,10,1]],"date-time":"2024-10-01T00:00:00Z","timestamp":1727740800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec>\n            <jats:title>OBJECTIVES:<\/jats:title>\n            <jats:p>Extracorporeal membrane oxygenation (ECMO) is often withheld in patients with significant neurologic injury or recent neurosurgical intervention due to perceived futility. Studies of neurosurgical interventions before or during ECMO are limited to case reports or single-center series, limiting generalizability, and outcomes in this population are unknown. We therefore sought to report the outcomes of ECMO patients with acute neurosurgical interventions at four high-volume ECMO and comprehensive stroke centers.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>DESIGN:<\/jats:title>\n            <jats:p>Retrospective case series.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>SETTING:<\/jats:title>\n            <jats:p>Four academic tertiary referral hospitals in the United States.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>PATIENTS:<\/jats:title>\n            <jats:p>Adults (<jats:italic toggle=\"yes\">n<\/jats:italic> = 24) having undergone neurosurgical procedures before or during ECMO.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>INTERVENTIONS:<\/jats:title>\n            <jats:p>None.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>MEASUREMENTS AND MAIN RESULTS:<\/jats:title>\n            <jats:p>We retrospectively reviewed adults at four institutions who had undergone neurosurgical procedures immediately before or during ECMO from 2015 to 2023. The primary outcome was survival to hospital discharge. Secondary outcomes included favorable neurologic outcome (Cerebral Performance Category 1 or 2) and neurosurgical complications. Twenty-four of 2957 ECMO patients (0.8%) were included. Primary indications for neurosurgical intervention included traumatic brain (<jats:italic toggle=\"yes\">n<\/jats:italic> = 8) or spinal (<jats:italic toggle=\"yes\">n<\/jats:italic> = 3) injury, spontaneous intracranial hemorrhage (<jats:italic toggle=\"yes\">n<\/jats:italic> = 6), and acute ischemic stroke (<jats:italic toggle=\"yes\">n<\/jats:italic> = 5). Procedures included extraventricular drain (EVD) and\/or intracranial pressure monitor placement (<jats:italic toggle=\"yes\">n<\/jats:italic> = 10), craniectomy\/craniotomy (<jats:italic toggle=\"yes\">n<\/jats:italic> = 5), endovascular thrombectomy (<jats:italic toggle=\"yes\">n<\/jats:italic> = 4), and spinal surgery (<jats:italic toggle=\"yes\">n<\/jats:italic> = 3). Fifteen patients (63%) survived to hospital discharge, of whom 12 (80%) were discharged with favorable neurologic outcomes. Survival to discharge was similar for venoarterial and venovenous ECMO patients (8\/12 vs. 7\/12; <jats:italic toggle=\"yes\">p<\/jats:italic> = 0.67) and those who had neurosurgery before vs. during ECMO (8\/13 vs. 7\/11; <jats:italic toggle=\"yes\">p<\/jats:italic> = 0.92). One patient (4%) experienced a neurosurgical complication, a nonlethal tract hemorrhage from EVD placement. Survival to discharge was similar for neurosurgical and nonneurosurgical ECMO patients at participating institutions (63% vs. 57%; <jats:italic toggle=\"yes\">p<\/jats:italic> = 0.58).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>CONCLUSIONS:<\/jats:title>\n            <jats:p>Patients with acute neurologic injury can feasibly undergo neurosurgery during ECMO or can undergo ECMO after recent neurosurgery. Larger studies are needed to fully understand risks for bleeding and other procedure-related complications.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/cce.0000000000001166","type":"journal-article","created":{"date-parts":[[2024,10,21]],"date-time":"2024-10-21T15:00:57Z","timestamp":1729522857000},"page":"e1166","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":3,"title":["Neurosurgical Procedures in Patients Requiring Extracorporeal Membrane Oxygenation"],"prefix":"10.1097","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6366-3299","authenticated-orcid":false,"given":"Ryan","family":"Lee","sequence":"first","affiliation":[{"name":"Division of Pulmonary and Critical Care, University of Maryland School of Medicine, Baltimore, MD."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samantha","family":"Helmy","sequence":"additional","affiliation":[{"name":"University of Rochester School of Medicine and Dentistry, Rochester, NY."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeronimo","family":"Cardona","sequence":"additional","affiliation":[{"name":"University of Rochester School of Medicine and Dentistry, Rochester, NY."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Zhao","sequence":"additional","affiliation":[{"name":"Johns Hopkins University School of Medicine, Baltimore, MD."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raymond","family":"Rector","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Cardiac Surgery, University of Maryland School of Medicine, Sewell, NJ."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Rabin","sequence":"additional","affiliation":[{"name":"Department of Surgery, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Mazzeffi","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, University of Virginia Health System, Charlottesville, VA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sung-Min","family":"Cho","sequence":"additional","affiliation":[{"name":"Neuroscience Critical Care and Cardiac Surgery Division, Departments of Neurology, Surgery, and Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gunjan","family":"Parikh","sequence":"additional","affiliation":[{"name":"Department of Neurology, Program in Trauma, University of Maryland Medical Center, University of Maryland School of Medicine, Baltimore, MD."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas A.","family":"Morris","sequence":"additional","affiliation":[{"name":"Department of Neurology, Program in Trauma, University of Maryland Medical Center, University of Maryland School of Medicine, Baltimore, MD."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Imad","family":"Khan","sequence":"additional","affiliation":[{"name":"Departments of Neurology and Neurosurgery, University of Rochester Medical Center, Rochester, NY."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2024,10,21]]},"reference":[{"key":"R1-20241021","article-title":"Registry > ECMO > Live Registry Dashboard > North America.","year":"2023"},{"key":"R2-20241021","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 Organization Database.","volume":"45","author":"Lorusso","year":"2017","journal-title":"Crit Care Med"},{"key":"R3-20241021","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1177\/08850666221139223","article-title":"Utilization and outcomes of extracorporeal membrane oxygenation following traumatic brain injury in the United States.","volume":"38","author":"Hatfield","year":"2023","journal-title":"J Intensive Care Med"},{"key":"R4-20241021","doi-asserted-by":"crossref","first-page":"1271","DOI":"10.1016\/j.injury.2023.01.002","article-title":"Extracorporeal membrane oxygenation in traumatic brain injury\u2014a retrospective, multicenter cohort study.","volume":"54","author":"Mader","year":"2023","journal-title":"Injury"},{"key":"R5-20241021","first-page":"332","article-title":"Veno-venous extracorporeal membrane oxygenation in patients with traumatic brain injuries and severe respiratory failure: A single-center retrospective analysis.","volume":"96","author":"Austin","year":"2023","journal-title":"J Trauma Acute Care Surg"},{"key":"R6-20241021","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1186\/s13017-020-00331-2","article-title":"Extracorporeal membrane oxygenation in trauma patients: A systematic review.","volume":"15","author":"Wang","year":"2020","journal-title":"World J Emerg Surg"},{"key":"R7-20241021","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1097\/MAT.0000000000001230","article-title":"Thrombosis and bleeding in extracorporeal membrane oxygenation (ECMO) without anticoagulation: A systematic review.","volume":"67","author":"Olson","year":"2021","journal-title":"ASAIO J"},{"key":"R8-20241021","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1001\/jamaneurol.2021.0084","article-title":"Recovery of consciousness and functional outcome in moderate and severe traumatic brain injury.","volume":"78","author":"Kowalski","year":"2021","journal-title":"JAMA Neurol"},{"key":"R9-20241021","doi-asserted-by":"crossref","first-page":"1259","DOI":"10.1056\/NEJMoa2214403","article-title":"Trial of endovascular thrombectomy for large ischemic strokes.","volume":"388","author":"Sarraj","year":"2023","journal-title":"N Engl J Med"},{"key":"R10-20241021","doi-asserted-by":"crossref","first-page":"856","DOI":"10.1001\/jamaneurol.2022.1991","article-title":"One-year outcome trajectories and factors associated with functional recovery among survivors of intracerebral and intraventricular hemorrhage with initial severe disability.","volume":"79","author":"Shah","year":"2022","journal-title":"JAMA Neurol"},{"key":"R11-20241021","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1186\/s13613-018-0375-9","article-title":"The effect of multidisciplinary extracorporeal membrane oxygenation team on clinical outcomes in patients with severe acute respiratory failure.","volume":"8","author":"Na","year":"2018","journal-title":"Ann Intensive Care"}],"container-title":["Critical Care Explorations"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/10.1097\/CCE.0000000000001166","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,21]],"date-time":"2024-10-21T15:01:04Z","timestamp":1729522864000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1097\/CCE.0000000000001166"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10]]},"references-count":11,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2024]]}},"URL":"https:\/\/doi.org\/10.1097\/cce.0000000000001166","relation":{},"ISSN":["2639-8028"],"issn-type":[{"value":"2639-8028","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10]]}}}