To report two cases of suspected spinal cord infarction resulting in paraparesis after use of Extracorporeal Membrane Oxygenation (ECMO) and review similar reported cases in the literature and recommendations for prevention of neurologic injury post-ECMO use.

Case 1 is a 55-year-old woman with pulmonary arterial hypertension and heart failure who underwent emergent surgery for acute cholecystitis, complicated by hemorrhagic and cardiogenic shock and placement of bilateral femoral venous-arterial (VA) ECMO for circulatory support. ECMO was removed after 11 days and she was found to have near-complete paraplegia and sensory deficit in the bilateral lower extremities. She was discharged to a rehabilitation facility after a month.

Case 2 is a 61-year-old woman with non-ischemic cardiomyopathy with a pacemaker, sarcoidosis and atrial fibrillation whose pacemaker malfunctioned leading to cardiogenic shock, requiring placement of VA ECMO and a temporary ventricular assist device, with subsequent development of a thigh hematoma. The devices were removed after 13 days, and an asymmetric paraparesis and sensory deficit were noticed. 

Literature search was performed using PubMed, Ovid and ClinicalKey databases for articles containing the following keywords: “Extracorporeal Membrane Oxygenation”, “ECMO”, “spinal cord infarction”, and “paraplegia”. No date or language limits were placed.

Our two patients underwent serial exams, electrodiagnostic studies and imaging and spinal cord infarction was suspected in both. Similar cases and review articles in the literature were reviewed with attention to possible risk factors and recommendations for prevention of neurologic injury after ECMO use. Studies are needed to clarify whether the underlying condition (e.g. heart failure) or the use of ECMO itself could lead to suspected spinal cord infarction.