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Updated: Jul 31, 2025
Point-of-Care Ultrasound for Peripheral Veno-Arterial Extracorporeal Membrane Oxygenation Without Left Ventricular Venting
Published on: January 17, 2025
Catheter directed thrombolysis for a pulmonary arterial thrombus on VA ECMO in a child - a case report
Livia Procopiuc1,2, Elizabeth Boot1, Paul James1
1Paediatric Intensive Care Unit, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.
Insights
Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is high-risk for pediatric cardiac transplant patients. This case highlights successful ultrasound-accelerated thrombolysis for pulmonary embolism in a child on V-A ECMO, leading to a favorable transplant outcome.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Critical Care Medicine
Background:
- Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is a high-risk support strategy for pediatric patients awaiting cardiac transplantation.
- Deteriorating cardiomyopathy necessitates advanced circulatory support, increasing patient vulnerability.
Introduction:
Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) as a bridge to cardiac transplantation is considered a high risk support strategy in the paediatric population.
Methods:
We describe the case of a 12 year old boy who required V-A ECMO support for rapidly deteriorating cardiomyopathy and developed a massive pulmonary embolus (PE) peri-cannulation. Subsequent investigations were also positive for heparin induced thrombocytopenia.
Results:
We elected to treat the PE with ultrasound accelerated catheter directed thrombolysis using the advantages of this minimally invasive targeted method to try and resolve the PE and avoid a cerebral haemorrhage, both of which would have taken the patient off the urgent transplant list.
Conclusion:
The PE resolved in 24 h and he went on to receive a cardiac transplant and have a favourable outcome.
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