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

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.