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

Abstract

Background Although life-threatening complications of extracorporeal membrane oxygenation (ECMO) are well described, non-life threatening complications are less known. Herein, we report a case of femoral neuropathy (FN) due to nerve compression caused by cannula compression and deep vein thrombosis (DVT) after successful ECMO therapy, which seriously undermined one’s quality of life. Case presentation A 70-year old male presented to the emergency department for chest pain. The patient had cardiac arrest before percutaneous coronary intervention (PCI) and was inserted with ECMO. Although he was successfully weaned from ECMO 4 days after PCI, he consistently complained swelling, abnormal sensation, and weakness in his right lower extremity, where the cannulas were inserted. Imaging studies showed deep vein thrombosis (DVT) in his right leg, which was further treated with anticoagulants. Symptoms, however, remained after the regression of DVT. Nerve conduction study revealed femoral neuropathy, which may have been caused by ECMO cannula compression and tissue swelling. Conclusion The current case proposes that non-life threatening complications of ECMO therapy can seriously affect quality of life. Venous drainage distant from the arterial cannula may prevent such complications.

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

“…Suboptimal knee positioning can enhance the compression of the fibular nerve at the fibular head level [ 15 , 19 ]. Continuous use of an automatically cycled blood pressure cuff can cause radial nerve injury [ 19 , 40 ]. We speculated that unexpected compressions or stretching associated with positioning or medical procedures might have resulted in the peripheral nerve injuries in our cases.…”

“…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 ].…”

“…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 ]. 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 ].…”

Neuromuscular Disorders in the Intensive Care Unit

“…In addition, femoral neuropathy has been described as a complication following extracorporeal membrane oxygenation (ECMO) and may become more prevalent as patients are treated with ECMO for COVID-19. 62…”

Risk factors for neuromuscular complications in lower limbs after lung transplantation

“…The authors suggested that prolonged immobility or impairment in circulation due to microvascular thrombosis or microembolization may have caused foot drop. Jang et al reported a case of femoral neuropathy after veno-arterial ECMO therapy and postulated that direct nerve compression from the ECMO cannula may have caused neuropathy ( 18 ). Despite these hypotheses, the exact cause of unilateral limb weakness after ECMO therapy in the absence of limb ischemia is still uncertain, and further studies are required to elucidate the mechanism of neuropathy.…”