Feasibility of Veno-Venous Extracorporeal Membrane Oxygenation Cannulation via the Neck in a Patient With Spinal Cord Injury Wearing a Halo Vest: A Case Report

To our knowledge, no previous reports have described the use of veno-venous extracorporeal membrane oxygenation (V-V ECMO) in patients wearing a halo vest. We present a case in which neck cannulation was safely performed through a modified approach. A 38-year-old woman with intractable epilepsy sustained a C5 anterior dislocation and high cervical spinal cord injury after a seizure-related fall. Conservative management was chosen, and sedation with mechanical ventilation was initiated while maintaining a halo vest. On day 20, she developed septic shock complicated by neurogenic shock, leading to cardiac arrest. Extracorporeal cardiopulmonary resuscitation was performed. Despite circulatory improvement, she developed severe respiratory failure and was transitioned to V-V ECMO on day 22. Cannulation was achieved using the right femoral vein and right internal jugular vein for drainage, with the right internal jugular vein serving as the return site. She was successfully weaned from V-V ECMO on day 30 and transferred to a rehabilitation hospital on day 128. This rare case demonstrates that, with appropriate precautions, cervical cannulation for V-V ECMO can be safely performed in patients wearing a halo vest, offering valuable clinical insight for managing similarly complex situations.