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Case Report
Veno-arterial extracorporeal membrane oxygenation under dual antiplatelet therapy, immediately after craniotomy
1 Tokyo Metropolitan Police Hospital, 4-22-1 Nakano, Nakanoku, Tokyo, Japan
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Hiroshi Shimizu
Tokyo Metropolitan Police Hospital, 4-22-1 Nakano, Nakanoku, Tokyo,
Japan
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Article ID: 101483Z01HS2024
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Shimizu H, Fukunaga Y, Komatsu Y, Yamashita T, Imamura T, Kanai M. Veno-arterial extracorporeal membrane oxygenation under dual antiplatelet therapy, immediately after craniotomy. Int J Case Rep Images 2024;15(2):121–125.ABSTRACT
Introduction: Extracorporeal membrane oxygenation (ECMO) is often considered a relative contraindication for traumatic brain injury and cerebral hemorrhage because fatal intracranial hemorrhage can occur. Moreover, dual antiplatelet therapy (DAPT)-related cerebral hemorrhage is associated with a high mortality rate. Herein, we report a case in which the patient was placed on ECMO under DAPT and managed without anticoagulation immediately after craniotomy.
Case Report: A 51-year-old man was hospitalized for surgery for Moyamoya disease. The surgery was performed as scheduled; however, the patient experienced cardiac arrest while awakening from anesthesia. After return of spontaneous circulation, during the emergency percutaneous coronary intervention (PCI), he was placed on ECMO for cardiac arrest which caused an electrical storm. Because computed tomography (CT) after PCI revealed a new cerebral hemorrhage, ECMO was managed with DAPT without anticoagulation. Subsequently, the CT showed no increase in hematoma; however, a thrombus was observed in the membrane of the ECMO, and ECMO was withdrawn on the 4th intensive care unit day.
Conclusion: Anticoagulation therapy with or without DAPT should not be used because of the risk of bleeding associated with veno-arterial ECMO immediately after craniotomy. Additionally, the risk of thrombosis may be high; therefore, additional care must be taken, and it is necessary to manage the ECMO circuit to consider the possibility of early replacement it too.
Keywords: Craniotomy, DAPT, ECMO, Intracranial hemorrhage
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Acknowledgments
We would like to thank Editage for English language editing.
Author ContributionsHiroshi Shimizu - Substantial contributions to conception and design, Acquisition of data, Drafting the article, Final approval of the version to be published
Yu Fukunaga - Acquisition of data, Revising it critically for important intellectual content, Final approval of the version to be published
Yumi Komatsu - Acquisition of data, Revising it critically for important intellectual content, Final approval of the version to be published
Tatsuya Yamashita - Acquisition of data, Revising it critically for important intellectual content, Final approval of the version to be published
Tomonori Imamura - Acquisition of data, Revising it critically for important intellectual content, Final approval of the version to be published
Masayuki Kanai - Acquisition of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2024 Hiroshi Shimizu et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
