Application of veno-venous extracorporeal membrane oxygenation in pediatric patient with severe brain injury: case report

摘要

Aim: Veno-venous extracorporeal membrane oxygenation (VV ECMO) is used to support lung function in patients with severe respiratory failure. A case is presented of a pediatric polytraumatized patient with severe brain injury to determine whether such patients can be treated with this method. Case Report: An eight-year-old patient was admitted in Intensive Care Unit (ICU) after being injured in a car accident. Transfer from another institution was agreed upon due to an unstable condition of vital functions during an operation. Multiple viscerocranial fractures, severe brain injury (subarachnoid haemorrhage and contusions) and acute respiratory distress syndrome were determined by examination. Patient was artificially ventilated and at admission, had extremely low oxygen saturation of 55%. The VV ECMO was set up by peripheral cannulation, after which saturation in arterial blood significantly improved. The respiratory parameters were controlled with VV ECMO . Findings with imaging techniques showed complete resorption of subarachnoidal bleeding and haemorrhagic focal points on the brain and better lung transparency. During the seventh day, VV ECMO was removed, with further ventilation support. On the tenth day of treatment, the patient was transferred to pediatric ICU. Conclusions: Despite numerous debates and potential risks, this case shows that severe brain damage is not an absolute contraindication for the application of VV ECMO. Since it carries certain risks, it is necessary to determine the actual need for each patient individually. New systems that do not require systemic application of anticoagulation present another possibility in treating these patients.