Balancing thrombosis and hemorrhage: anticoagulation-free VA-ECMO with a multidisciplinary strategy for cerebellar hemorrhage complicated by takotsubo syndrome.

Xianli Chen, Yalan Qin, Wenqi Huang, Youhua Wang

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Article in BMC anesthesiology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

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1citing papers in PubMed

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1 citing paper in PubMed.

Accidental hypothermia.Nature reviews. Disease primers · 2026
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4 authors.

Xianli ChenDepartment of Critical Care Medicine, The Affiliated Dazu's Hospital of Chongqing Medical University, No. 1073 Second Ring South Road, Tangxiang Subdistrict, Hongxing Community, Dazu District, Chongqing, 402360, China.

Yalan QinDepartment of Critical Care Medicine, The Second Affiliated Hospital of Chongqing Medical University, No. 74 Linjiang Road, Yuzhong District, Chongqing, 400010, China.

Wenqi HuangDepartment of Critical Care Medicine, The Second Affiliated Hospital of Chongqing Medical University, No. 74 Linjiang Road, Yuzhong District, Chongqing, 400010, China.

Youhua WangDepartment of Critical Care Medicine, The Affiliated Dazu's Hospital of Chongqing Medical University, No. 1073 Second Ring South Road, Tangxiang Subdistrict, Hongxing Community, Dazu District, Chongqing, 402360, China. yundfq1798@qq.com.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundTakotsubo syndrome (TTS) following intracranial hemorrhage, particularly cerebellar hemorrhage is rare. The use of extracorporeal membrane oxygenation (ECMO) in such cases poses significant challenges due to the bleeding-thrombosis paradox. CASE PRESENTATION: We report a 19-year-old female with cerebellar hemorrhage and TTS who developed refractory cardiogenic shock. Despite maximal pharmacologic support, anticoagulation-free venoarterial ECMO (VA-ECMO) was initiated due to the high risk of intracranial bleeding. ECMO stabilized hemodynamics; however, left femoral artery thrombosis occurred postdecannulation. Multidisciplinary collaboration prioritized cerebral protection, delaying thrombectomy until neurological stabilization. The patient regained consciousness and underwent successful delayed intervention.

conclusionThis first reported case demonstrates the feasibility of anticoagulation-free VA-ECMO in patients with cerebellar hemorrhage with TTS. Multidisciplinary decision-making and staged management are critical for balancing thrombosis and hemorrhage risks.

Indexed as

Extracorporeal Membrane OxygenationIntracranial HemorrhagesTakotsubo CardiomyopathyThrombosisAnticoagulantsFemaleHumansShock, CardiogenicYoung AdultAnticoagulantsAnticoagulation-freeCerebellar hemorrhageMultidisciplinary collaborationTakotsubo syndromeVA-ECMO

Identifiers

PMID40883698

DOI10.1186/s12871-025-03312-7

PMCPMC12395905

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