Introduction
Recently, Extracorporeal Membrane Oxygenator (ECMO) therapy is increasing because of the higher interest in the critical care medicine since Middle East Respiratory Syndrome (MERS) crisis in Korea. ECMO is a type of extracorporeal life support where an external circuit drains venous blood from the patient to a gas exchange device (membrane oxygenator) where blood oxygenates and extracts carbon dioxide. Then this blood returns the patient systemic circulation through a perfusion cannula. ECMO improves mortality of patients with respiratory and/or cardiac failure which are unresponsive to conventional therapy. The common complications by ECMO are known as renal failure, significant infection, and bleeding events. However, neurological complications on the lower extrimity caused by ECMO therapy are rarely reported.
Case presentation
We report an unusual case of 33-year-old man developed monoplegia with right lumbosacral plexopathy after venoarterial-ECMO therapy. He had undergone VA-ECMO therapy because of alveolar hemorrhage and acute respiratory distress syndrome caused by ventilator associated pneumonia for 11 days. He presented with motor weakness, paresthesia, and swelling on right lower extremity about 3 days after ECMO disconnection. Physical examination of the motor system showed hip flexor 3-/5, knee extensor 3/5, ankle dorsiflexor 1/5, great toe extensor 1/5, and ankle plantar flexor 1/5 in the affected limb according to Medical Research Council Scale (MRC) for Muscle strength. Ultrasound showed hematoma at right inguinal area while no evidence of deep vein thrombosis (Fig. 1). Initial findings of nerve conduction study and needle electromyography showed right sacral plexopathy and peripheral polyneuropathy (Table 1). Eleven weeks after onset, there was no improvement in muscle strength. Physical examination showed hip flexor 4-/5, knee extensor 4/5, ankle dorsiflexor 1/5, great toe extensor 1/5, and ankle plantar flexor 1/5 in the affected limb according to MRC. Follow up findings of nerve conduction study and needle electromyography showed right lumbosacral plexopathy and peripheral polyneuropathy (Table 2). Therefore, it should be considered the possibility of neurological complication such as lumbosacral plexopathy after VA-ECMO therapy.
Discussion
The authors experienced a case of the lumbosacral plexopathy after VA-ECMO therapy, but there is reported no domestic cases yet. If there is clinical symptoms such a change of motor power and sense after VA-ECMO therapy, the possibility of peripheral nerve injuries including the lumbosacral plexopathy must be attended. For accurate early diagnosis, physical examination, imaging tests (such as ultrasound and magnetic resonance imaging) and electrical diagnostic tests should be given priority consideration. |
