Chlorine-induced severe ARDS in an adolescent rescued with VV-ECMO: a case report with 6-month functional follow-up

Chlorine is a potent irritant gas with asphyxiant toxicity. Depending on the concentration and duration of exposure, intentional or accidental inhalation can rapidly cause marked injury to the respiratory tract and, in some cases, leave patients with sustained ventilatory impairment. At present, there is no approved antidote that specifically targets chlorine intoxication. In this context, extracorporeal membrane oxygenation (ECMO) has been applied as a salvage therapy to provide temporary cardiopulmonary support for life-threatening respiratory failure that persists despite maximal conventional management. Among available configurations, veno-venous ECMO (VV-ECMO) delivered through a dual-lumen cannula (DLC) was designed to permit single-site cannulation and may lessen cannulation-related complications, reduce recirculation, and support earlier mobilization-including getting patients out of bed.

To our knowledge, this is among the first reports in adolescents with longitudinal functional follow-up using chest computed tomography (CT) scans and pulmonary function tests in an adolescent with chlorine intoxication-induced severe acute respiratory distress syndrome (ARDS) who was successfully rescued with dual-lumen cannula veno-venous ECMO (DLC-VV-ECMO).

In severe ARDS resulting from chlorine intoxication, VV-ECMO may function as a salvage strategy when conventional treatment is insufficient, providing temporary extracorporeal oxygenation and thereby preserving a window for pulmonary recovery and stabilization of other organ systems. During the acute phase of chlorine intoxication, prophylactic antibiotics are generally not recommended because the underlying lung injury is primarily caused by chemical insult and oxidative damage rather than established infection. Our findings also suggest that recovery of pulmonary function in adolescents after chlorine intoxication-induced severe ARDS may take longer than 6 months. Moreover, early suicide risk identification and timely mental health intervention are essential to prevent subsequent catastrophic outcomes.