Incomplete Cushing's reflex in extracorporeal membrane oxygenation

Sung-Min Cho; Ahmet Kilic; Jeffrey M Dodd-O

doi:10.1177/0391398819893701

Incomplete Cushing's reflex in extracorporeal membrane oxygenation

Int J Artif Organs. 2020 Jun;43(6):401-404. doi: 10.1177/0391398819893701. Epub 2019 Dec 19.

Authors

Sung-Min Cho¹, Ahmet Kilic², Jeffrey M Dodd-O³

Affiliations

¹ Neurosciences Critical Care Division, Departments of Neurology, Anesthesiology, and Critical Care Medicine and Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
² Department of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
³ Department of Anesthesia and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

PMID: 31856638
DOI: 10.1177/0391398819893701

Abstract

We report a case of intracranial hypertension presenting with bradycardia as the only component of Cushing's triad in a patient on extracorporeal membrane oxygenation. A 41-year-old woman with recurrent driveline infections of HeartMate-II had sternotomy and debridement that was complicated by right ventricular failure requiring veno-arterial extracorporeal membrane oxygenation. Patient was comatose and acute onset of bradycardia occurred without any change in blood pressure or respiration. Computed tomography of brain demonstrated an uncal herniation from diffuse cerebral edema. Acute onset of bradycardia in comatose patients may be the sole component of Cushing's triad in laminar flow circulatory support.

Keywords: Cushing’s reflex; Extracorporeal membrane oxygenation; brain herniation; continuous flow pump.

Publication types

Case Reports

MeSH terms

Adult
Bradycardia / etiology*
Cushing Syndrome / complications*
Extracorporeal Membrane Oxygenation / methods*
Female
Heart Failure / complications*
Heart Failure / therapy
Humans