Ann Rehabil Med.  2014 Aug;38(4):575-580. 10.5535/arm.2014.38.4.575.

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

• Go JY
• Min YS
• Jung TD

• KMID: 2165743
• DOI: http://doi.org/10.5535/arm.2014.38.4.575

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.

Keyword

Anterior compartment syndrome; Extracorporeal membrane oxygenation

MeSH Terms

Adolescent
Anterior Compartment Syndrome
Compartment Syndromes*
Drowning
Electric Stimulation
Electromyography
Extracorporeal Membrane Oxygenation*
Extremities*
Humans
Korea
Leg
Male
Membranes
Muscle Strength
Muscles
Neural Conduction
Oxygen
Rehabilitation
Tibia
Oxygen

Figure

• 

  Fig. 1 Duplex ultrasonography performed in right leg. (A) The right common femoral vein (CFV); (B) deep femoral vein (DFV) and superficial femoral vein (SFV); and (C) popliteal vein (PV) is compressed by leg swelling (D). Ultrasonography showed no evidence of deep vein thrombosis. COMP, compression.

• 

  Fig. 2 Chronological change of potassium ion (A), AST and ALT (B), and myoglobulin (C) after venoarterial extracorporeal membrane oxygenation treatment (VA-ECMO Tx). It shows peak values when the right leg swelling are observed, about 10-16 hours after ECMO disconnection (underlined). K+, potassium; AST, aspartate aminotransferase; ALT, alanine aminotransferase.

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