Delayed Onset of Acute Limb Compartment Syndrome With Neuropathy After Venoarterial Extracorporeal Membrane Oxygenation Therapy

Abstract

Acute limb compartment syndrome (ALCS) is defined as compound symptoms resulting from poor oxygenation and decreased nutrition supply to muscles and nerves in a tightly confined compartment. The most common cause of ALCS is tibia fracture, followed by blunt trauma to soft tissue. However, non-traumatic causes are rare. We report an iatrogenic, non-traumatic ALCS case after venoarterial extracorporeal membrane oxygen (VA-ECMO) therapy. A 14-year-old male received VA-ECMO therapy due to cardiorespiratory failure after drowning. Although he had no symptoms during therapy, leg swelling appeared 10 hours after ECMO treatment. Two days after the leg swelling, the patient underwent a fasciotomy. Unfortunately, nerve conduction studies and electromyography showed multiple neuropathies in the lower leg. Despite 2 weeks of rehabilitation with electrical stimulation, an exercise program, and physical therapy, there was no definite change in muscle strength. To our knowledge, this is the first reported case of non-traumatic ALCS after VA-ECMO therapy in Korea.

A Drop Foot Case Report After Having a Common Femoral Artery Cannulation for Venoarterial Extracorporeal Membrane Oxygenation: Case Report

“…When the anterior compartment pressure exceeds the intra-arterial pressure that this will produce venous stasis and also arterial occlusion, it results in muscles swelling and eventually necrosis of muscle and nerves duo to prolonged limb ischaemia. The nerve damage may vary depending on the duration of ischemia and degree of occlusion (10). In this case that developed drop foot in the postoperative period, it was observed necrosis of developed secondary to ischemia, impairment of arterial flow and venous stasis in dUSG in accordance with the EMG and clinical examination.…”

Intensive Care Unit-Acquired Weakness and Positioning-Related Peripheral Nerve Injuries in COVID-19: A Case Series of Three Patients and the Latest Literature Review

“…In addition to intensive respiratory care and positionings, other procedures can also cause peripheral nerve injuries. ECMO, for example, is reported as a possible cause of lower limb peripheral nerve injuries, although no COVID-19 cases have been reported [ 40 , 41 , 42 , 43 ]. According to the literature, bulky cannulas placed on the femoral artery and vein can damage the femoral nerve [ 40 , 41 ].…”

“…According to the literature, bulky cannulas placed on the femoral artery and vein can damage the femoral nerve [ 40 , 41 ]. Furthermore, compartment syndrome, a possible complication of the procedure, can also cause fibular, tibial, and sural nerve injuries on the same side of cannulation [ 42 , 43 ]. Fortunately, case 1 did not show the peripheral nerve injuries associated with ECMO, although the patient underwent the procedure.…”

Femoral neuropathy following venoarterial-extracorporeal membrane oxygenation therapy: a case report

“…As the clinical outcomes of ECMO therapy is improving, attention to the complications that determine the post-ECMO quality of life are emerging. Neuropathy caused by limb ischemia [4] or compartment syndrome [5] following ECMO therapy have been observed. However, FN caused by DVT and/or cannula-related nerve compression after ECMO therapy have not been reported.…”