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Venovenous extra corporeal life support in an infant with foreign body aspiration: A case report
Ahmed S AlKhalifah1, Nada A AlJassim1
1Department of Pediatric Critical Care, Critical Care Center, King Fahad Medical City, Riyadh, Saudi Arabia.
Insights
Foreign body aspiration (FBA) in children can cause severe respiratory failure. This case shows ultrasound-guided percutaneous venovenous extracorporeal membrane oxygenation (VV-ECMO) is a feasible rescue therapy for infants with FBA.
Area of Science:
- Pediatric critical care medicine
- Interventional pulmonology
- Pediatric cardiology
Background:
- Foreign body aspiration (FBA) is a critical pediatric emergency, often leading to severe respiratory compromise.
- Management can be complex, requiring advanced life support like high-frequency oscillatory ventilation (HFOV) or extracorporeal membrane oxygenation (ECMO).
- This case explores the use of ultrasound (US) for percutaneous catheterization in infants undergoing ECMO for FBA.
Observation:
- A 10-month-old girl with a dislodged metallic foreign body in her right main bronchus developed refractory respiratory failure despite maximal ventilation.
- She required venovenous ECMO (VV-ECMO) as a bridge to bronchoscopic removal and lung recovery.
- Ultrasound guidance was utilized for percutaneous cannulation, facilitating VV-ECMO initiation.
Findings:
- The patient successfully bridged FBA-induced respiratory failure with VV-ECMO for 166 hours.
- Ultrasound-guided percutaneous cannulation proved feasible and safe in this infant, despite vessel size challenges.
- The child was weaned from ECMO, extubated, and discharged without neurological or respiratory sequelae.
Implications:
- VV-ECMO is an effective rescue therapy for pediatric respiratory failure secondary to FBA.
- Ultrasound-guided percutaneous cannulation enhances the feasibility and safety of ECMO in infants.
- This approach may improve outcomes for critically ill children with FBA.
Background:
Foreign body aspiration (FBA) is a life-threatening emergency and a common cause of morbidity and morbidity in children. FBA can lead to rapidly progressive respiratory failure. Stabilizing patients after FBA for bronchoscopic removal of the aspirated object can be complex and may necessitate advanced support such as high-frequency oscillatory ventilation (HFOV) or extracorporeal membrane oxygenation (ECMO). This case report presents the feasibility of using ultrasound (US) in percutaneous catheterization in infants and the benefit of using venovenous ECMO (VV-ECMO) as rescue therapy in FBA.
Case Summary:
A 10-month-old girl accidently aspirated a metallic piece that was dislodged further to the right main bronchus after failed trials to remove it. She was intubated and mechanically ventilated, complicated by milk aspiration and bilateral pneumothoraces secondary to high-pressure lung ventilation. She had refractory mixed respiratory failure despite high settings of HFOV and inhaled nitric oxide. Venovenous ECMO (VV-ECMO) was initiated for stabilization and a bridge for bronchoscopic foreign body removal and awaiting lung recovery. She was weaned off ECMO after 166 hours. The patient was extubated after a few days and discharged home 28 days after admission without clinical evidence of neurological or respiratory complications. ECMO has been described in the literature as rescue therapy for FBA resulting in respiratory failure. However, ECMO cannulation in children under these circumstances is challenging because of vessel size restrictions. Two-vessel cannulation or dual-lumen cannulation are available options via open cut-down or percutaneous cannulation techniques, depending on the general expertise. The use of vascular ultrasound to assess vessel size is a helpful tool for cannulating infants.
Conclusion:
VV-ECMO support is expanding for respiratory failure in pediatric patients. Percutaneous cannulation in infants and children for VV-ECMO is safe and feasible.
