Surviving 49 days on extracorporeal life support complicated by lung necrosis, pneumothorax, intrathoracic hematoma, and bronchopleural fistulas in a 13-year-old

Abstract

The use of extracorporeal membrane oxygenation (ECMO) or extracorporeal life support (ECLS) has rapidly grown since the 1960s. Improvements in materials, device mechanics, the treatment of the underlying conditions, and provider proficiency, have resulted in better outcomes. The most common indication for ECLS in the pediatric population is viral pneumonia [1]. Complications secondary to ECLS are common with thromboembolic events (8%) and hemorrhage (27%) being amongst the most frequent [2]. We report a case of a 13-year-old female who presented to the Emergency Department with altered mental status and respiratory distress following a treatment course for influenza. She was diagnosed with multifocal pneumonia and developed fulminant respiratory failure requiring ECLS. The causative organism was later found to be Methicillin-Resistant Staphylococcus Aureus (MRSA). She was maintained on ECLS for 49 days and developed secondary complications of lung necrosis, an intrathoracic hematoma, and multiple bronchopleural fistulae. She was managed non-operatively for these complications until she stabilized enough to be weaned off ECMO. In this particular case, we resisted the urge to surgically intervene until she was decannulated. On day 86, she underwent a thoracotomy for evacuation of an intrathoracic hematoma and repair of a bronchopleural fistula. The patient survived and was discharged on hospital day 146. Currently, she is thriving and recovering well. We present this case due to its unusual duration of ECLS and to highlight the decision-making behind the initial non-operative management of the life-threatening complications that ensued.