Spinal cord infarction (SCI) or ischemia is a rare but devastating complication of venoarterial extracorporeal membrane oxygenation (VA ECMO). The natural course and outcomes are poorly studied.

We completed a literature review on ischemic spinal cord injury in patients on VA ECMO and analyzed the published case reports and case series with individual patient characteristics. We also added 3 previously unpublished cases from our own experience.

The final sample included 30 adult patients on VA ECMO for cardiogenic shock secondary to various etiologies. The mean age was 47.7 ± 17.8 years with equal distribution between men and woman. The total duration on ECMO ranged from 3 to 47 days with a median of 10 days. In all patients, ECMO was placed peripherally via an arterial cannula in the femoral artery. All 30 patients developed either paraplegia (27/90%) or weakness (3/10%) of both lower extremities. Magnetic resonance imaging of the spine was consistent with infarction in 88.5% and ischemia in the rest. On follow-up, there were no cases of complete recovery. Partial recovery with significant limitations of mobility was noted in half of them. The remaining half had no signs of neurological recovery. Survival to discharge was reported in 24 cases. Of these cases, 17/70.8% survived and 7/29.2% died.

Spinal infarction/ischemia on VA ECMO typically presents with paraplegia of lower extremities with low potential for even partial recovery. Because no treatment is currently available, the efforts should be focused on prevention. Several strategies have been proposed, but they need further testing under controlled settings.