ECMO is a lifesaving intervention often withheld in patients requiring acute neurosurgical intervention given associated risks. Outcomes for ECMO patients requiring neurosurgery are rarely reported.

In total, 24 patients were evaluated. Of the total, 88% were male with a mean age of 40.9 years. Neurosurgical intervention indications included traumatic brain injury (n=7), spinal injury (n=3), spontaneous intracranial hemorrhage (n=6) and acute ischemic stroke (n=5). Neurosurgical procedures performed included EVD/ICP monitor placement (n=10), craniectomy/craniotomy (n=5), endovascular thrombectomy (n=4) and spinal surgery (n=3). Neurosurgery was performed during ECMO in 11 (46%) patients while the remainder occurred prior to ECMO. ECMO indications included acute respiratory distress syndrome (ARDS) (n= 11), cardiac arrest (n=6) and refractory shock (n=6). Sequential organ failure assessment (SOFA) scores on cannulation day averaged 10.7. 

Fifteen (63%) patients survived discharge, 12 (80%) of whom with favorable neurologic outcome (CPC 1-2).
Survival to discharge was similar between those who had neurosurgical procedures performed while on ECMO (7/11, 63%) and prior to ECMO (8/13, 62%). ECMO related complications occurred in 17/24 (62.9%) patients while 3/24 (12.5%) experienced a complication related to neurosurgery. The cohort had similar survival to discharge as a comparison of Extracorporeal Life Support Organization registry patients from 2018-2022 of 53.3%.