Successful use of extracorporeal membrane oxygenation in a child with obstructive shock due to massive bilateral pulmonary embolism

Abstract

Background:

Acute massive pulmonary embolism (PE) is a very rare condition in children. We report the successful use of veno-arterial extracorporeal membrane oxygenation (VA ECMO) as a lifesaving modality in a child with acute massive PE.

Case presentation:

A nine-year-old female with spinal muscular atrophy type 1, chronic respiratory failure with tracheostomy and ventilator dependence presented with tachypnea and hypoxia. She had recent coiling of her pulmonary arterio-venous malformation. A chest computerized tomography scan showed massive bilateral PE. Urgent catheter-directed thrombolysis failed. She was placed on VA-ECMO with stabilization of hemodynamics. She underwent surgical thrombo-embolectomy followed by weaning of ECMO support.

Discussion:

The use of VA ECMO supported the cardio-respiratory status and perfusion to facilitate surgical embolectomy.

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References

Silverstein

Heit

Mohr

Petterson

O’Fallon

Melton

III . Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study. Arch Intern Med 1998; 158: 585–593.

Van Ommen

Heijboer

Buller

Hirasing

Heijmans

Peters

Venous thromboembolism in childhood: a prospective two-year registry in the Netherlands. J Pediatr 2001; 139: 676–681.

Andrew

David

Adams

et al . Venous thromboembolic complications (VTE) in children: first analyses of the Canadian Registry of VTE. Blood 1994; 83: 1251–1257.

Jaff

McMurtry

Archer

et al . Management of massive and submissive pulmonary embolism, iliofemoral deep vein thrombosis and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association. Circulation 2011; 123: 1788–1830.

Konstantinides

Torbicki

Agnelli

et al . 2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism. The Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). Eur Heart J 2014; 35: 3033–3080.

Buck

Connors

Coon

Weintraub

Wesley

Coran

AG.

Pulmonary embolism in children. J Pediatr Surg 1981; 16: 385–391.

N, Rossi

De Rosa

Goldhaber

. Massive pulmonary embolism. Circulation 2006; 113: 557–582.

Brechot

Luyt

Schmidt

et al . Venoarterial extracorporeal membrane oxygenation support for refractory cardiovascular dysfunction during severe bacterial septic shock. Crit Care Med 2013; 41: 1616–1626.

Yusuff

Zochios

Vuylsteke

Extracorporeal membrane oxygenation in acute massive pulmonary embolism: a systemic review. Perfusion 2015; 30: 611–616.

10.

Combes

Leprince

Luyt

CE.

Outcomes and long-term quality-of-life of patients supported by extracorporeal membrane oxygenation for refractory cardiogenic shock. Crit Care Med 2008; 36: 1404–1411.

11.

Kjærgaard

Rasmussen

de Neergaard

Rasmussen

Kristensen

SR.

Extracorporeal cardiopulmonary support may be an efficient rescue of patients after massive pulmonary embolism. An experimental porcine study. Thromb Res 2012; 129: e147–e151.

12.

Konstantinides

SV.

2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J 2014; 35: 3145–3146.

13.

Raffini

Prevalence of bleeding complication after systemic thrombolysis is high as 40%. Thrombolysis for intravascular thrombosis in neonates and children. Curr Opin Pediatr 2009; 21: 9–14.

14.

Razo-Vazquez

Thornton

Extracorporeal membrane oxygenation - what the nephrologist needs to know. Adv Chronic Kidney Dis 2016; 23: 146–151.

15.

Malekan

Saunders

et al . Peripheral extracorporeal membrane oxygenation: comprehensive therapy for high-risk massive pulmonary embolism. Ann Thorac Surg 2012; 94: 104–108.

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