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Use of Extracorporeal Membrane Oxygenation Support During an Emergent Decompression of a Thoracic Epidural Abscess

Chauhan, Aakash MD, MBA*; Moraca, Robert J. MD; Altman, Daniel T. MD*

doi: 10.1097/BRS.0b013e3182972f7f
Case Report

Study Design. Case report.

Objective. To present the first reported case of using extracorporeal membrane oxygenation (ECMO) support in an emergent decompression and evacuation of a thoracic epidural abscess.

Summary of Background Data. Thoracic epidural abscesses with neurological deficits require surgical evaluation and intervention in most cases. We report a case of a 35-year-old patient with an acute onset of paraplegia diagnosed with a thoracic epidural abscess. The patient was emergently taken to the operating room and was unable to tolerate prone positioning secondary to cardiopulmonary collapse. ECMO was initiated for cardiopulmonary support to complete the case.

Methods. Retrospective chart review of patient case.

Results. The patient was stabilized with ECMO support and tolerated a T4–T8 laminectomy and decompression. The source of the patients abscess was hematogenous and at 6 months of clinical follow-up, the patient has no motor or sensory function of his bilateral lower extremities.

Conclusion. The use of ECMO support in adult spinal surgery has not been previously reported in the literature. Therefore we describe the first reported use of ECMO to maintain cardiopulmonary support in a patient unable to tolerate prone positioning during spine surgery. ECMO support can be a viable option in adult patients who need emergent spinal surgery but are unable to tolerate prone positioning secondary to cardiopulmonary complications.

Level of Evidence: N/A

We describe the first reported case of using extracorporeal membrane oxygenation (ECMO) to stabilize a 35-year-old male with a thoracic epidural abscess unable to tolerate prone positioning secondary to acute cardiopulmonary failure. After ECMO was initiated, the patient tolerated a thoracic decompression without complication.

*Department of Orthopaedics, and

Department of Thoracic and Cardiovascular Surgery, Allegheny General Hospital, Pittsburgh, PA.

Address correspondence and reprint requests to Daniel T. Altman, MD, Allegheny General Hospital, 1307 Federal St, Floor 2, Pittsburgh, PA 15212; E-mail:

Acknowledgment date: February 18, 2013. Acceptance date: April 10, 2013.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: grants pending.

© 2013 by Lippincott Williams & Wilkins