Pearls for addressing traumatic cranio-cervical instability in a patient on extracorporeal membrane oxygenation (ECMO)

BACKGROUND: Concurrent craniocervical dissociation in a multi-trauma patient requiring venous-venous extracorporeal membranous oxygenation (ECMO) poses significant challenges in its management. PURPOSE: This article describes the nuances of the surgical decision-making in a complex case of a polytrauma patient with craniocervical dissociation who required concurrent ECMO. STUDY DESIGN/ SETTING: Case report and literature review METHODS: The authors describe a complex case of a patient with craniocervical dissociation requiring ECMO and who was managed surgically in a level 1 trauma centre in Victoria, Australia after sudden neurological deterioration whilst in a halo-vest. A literature search using appropriate medical subject headings and keywords was performed to identify published cases of craniocervical dissociation in patients requiring concurrent ECMO. RESULTS: Literature search yielded twenty-seven articles, with only two relevant articles identified for full text review. Only one article was found to be relevant, which however did not provide detailed discussion on surgical aspect of the pathology. CONCLUSION: To the authors' knowledge, this is the first report of management of craniocervical dissociation in a patient requiring ECMO due to polytrauma focused on the nuances of the complex surgical decision-making which is required for proper management of such critical condition.