Late presentation of foreign body aspiration requiring extracorporeal membrane oxygenation support for surgical...

We present the case of a near fatal aspiration of a foreign body requiring extracorporeal membrane oxygenation (ECMO) support. The use of ECMO to support treatment for a foreign body in the distal trachea is rare and there are only two cases reported in the literature. A 13-year-old male presented with a three-weeks' history of a cough and swinging fevers. Subsequent investigation revealed a foreign body causing collapse of the right middle and lower lobe with abscess formation. On attempted bronchoscopic removal, copious amounts of pus were aspirated, soiling both lungs. The patient became severely hypoxic and hypotensive. He was unstable on ventilation and inotropes and ECMO was used to stabilise him and facilitate removal of the foreign body and infected lung. He made excellent recovery and suffered no neurological sequalae. This is the first reported use of ECMO support for an acute presentation of a chronic problem. If the patient is too unstable for bronchoscopy, ECMO can be used to temporarily stabilise the patient allowing safe removal of the object. If the patient is acutely unwell and septic, ECMO should be more readily considered.