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Intrapleural fibrinolysis during pediatric extracorporeal life support

Cordelie E Witt1, Andrew L Mesher1, Joshua L Hermsen2

  • 1Department of Surgery, University of Washington School of Medicine, Seattle, WA, USA.

World Journal for Pediatric & Congenital Heart Surgery
|December 31, 2014
PubMed

Insights

Pediatric patients on extracorporeal life support (ECLS) with retained hemothorax can be safely treated with intrapleural fibrinolysis. This nonsurgical approach avoids the risks of surgery during ECLS, offering a viable alternative for managing hemothorax.

Area of Science:

  • Pediatric critical care medicine
  • Cardiovascular surgery
  • Pulmonary medicine

Background:

  • Pediatric patients requiring extracorporeal life support (ECLS) for cardiorespiratory failure face high risks of intrapleural hemorrhage.
  • Retained hemothorax in these patients necessitates intervention to prevent complications like empyema and fibrothorax.
  • Surgical evacuation, the standard treatment, is hazardous during ECLS due to bleeding risks.

Observation:

  • This study reports on two pediatric cases of retained hemothorax during ECLS.
  • Both patients were treated with intrapleural fibrinolysis using tissue plasminogen activator.
  • The treatment aimed to facilitate nonsurgical evacuation of the hemothorax.

Findings:

  • Intrapleural fibrinolysis was successfully and safely administered to both pediatric patients.
  • The nonsurgical approach effectively managed the retained hemothorax during ECLS.
  • This method provided an alternative to hazardous surgical interventions.

Implications:

  • Intrapleural fibrinolysis represents a safe and effective nonsurgical option for pediatric patients with retained hemothorax on ECLS.
  • This approach may reduce the risks associated with surgical interventions in critically ill pediatric patients.
  • Further research could explore the broader application of intrapleural fibrinolysis in similar pediatric critical care scenarios.

Keywords:
extracorporeal membrane oxygenationhemothoraxpediatricpleural space

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