Electrodiagnostic / Neuromuscular Medicine
Andrew Woods, DO
PGY-4
University of Louisville
Crestwood, Kentucky, United States
Jacob Schultz, MD
Assistant Professor, Attending Physician
University of Louisville
Louisville, Kentucky, United States
Andrew J. Woods, DO
University of Louisville
Louisville, Kentucky, United States
Femoral Neuropathy Caused by Iliacus Hematoma After ECMO Cannulation
Case Description:
A 42-year-old male with a history of cardiopulmonary disease was admitted with acute hypoxic respiratory failure requiring veno-venous extracorporeal membrane oxygenation (VV-ECMO) and tracheostomy. After stabilization and decannulation, he transferred to acute inpatient rehabilitation. Early in his rehab, he reported persistent left leg weakness, paresthesia, and hip pain. Imaging showed a large iliacus hematoma with evidence of femoral nerve involvement. He was taken off anticoagulation, and surgical teams recommended conservative management. He actively participated in therapies focused on mobility and strength recovery. At the time of rehab discharge, his neurological deficits were improving but still limiting his function.
Discussions:
This case highlights a rare but significant complication of ECMO cannulation. Iliacus hematomas are common in anticoagulated patients, but the timing related to cannulation suggests that local vessel trauma likely caused the hemorrhage. The femoral neuropathy that resulted presented with weakness, numbness, and hip pain, which were initially mistaken for critical illness and deconditioning. Physiatrists played a vital role in identifying the unusual pattern of deficits, prompting the necessary imaging, and differentiating hematoma-related neuropathy from widespread ICU-acquired weakness. Additionally, PM&R guided a rehabilitation program focused on neurologic recovery, including gait training and compensatory strategies, while working closely with surgical and medical teams on anticoagulation and hematoma treatment. This case emphasizes the need for vigilance regarding post-procedural complications like hematomas in ECMO patients, where early detection can prevent delays in diagnosis and improve functional outcomes.
Conclusions:
Iliacus hematoma with femoral neuropathy is a rare but serious complication that can occur after ECMO cannulation. Early detection and prompt imaging are essential to differentiate it from critical illness weakness and to plan appropriate rehabilitation. A multidisciplinary approach enhances both patient safety and functional recovery.
