Extracorporeal membrane oxygenation for life-threatening measles in children: a case series

Measles is resurgent worldwide, and although vaccine-preventable, severe disease can progress to cardiorespiratory failure refractory to conventional support. This study aimed to determine whether extracorporeal membrane oxygenation (ECMO) is feasible in children with measles. A retrospective case series at a tertiary pediatric intensive care unit (PICU) with a regional ECMO program, of all children younger than 18 years with laboratory-confirmed measles who received ECMO during the August 2025-May 2026 outbreak. Of 49 children with measles admitted to the PICU, 10 received ECMO. Five were male; median age was 11 months (IQR, 10-24), and none had completed age-appropriate vaccination. Indications were septic shock or cardiorespiratory failure (n = 5), acute respiratory distress syndrome with septic shock (n = 2), hypoxemic respiratory failure (n = 2), and suspected myocarditis (n = 1). Seven received venoarterial, 1 veno-venoarterial, and 2 venovenous ECMO. Bacteremia preceded ECMO in 5 children and positive sputum culture in 8. Candida tropicalis candidemia developed in 3 of the first 5 patients, with none among the subsequent 5 after antifungal prophylaxis at cannulation. Left ventricular dysfunction was present in 7 of 9 assessed, 4 required decompression, and neuroimaging was abnormal in 4 of 8 imaged. Six children (60%) survived to discharge.

ECMO was feasible and potentially lifesaving in measles-associated cardiorespiratory failure, with survival comparable to other high-acuity pediatric indications, but the course was complicated by bacterial and fungal coinfection, cardiac dysfunction, and neurologic injury. These resource-intensive presentations occurred exclusively in unvaccinated children and were preventable, underscoring measles vaccination coverage as a public health priority.

• Measles is resurgent worldwide and can cause severe respiratory, cardiac, and immune complications in children. • Measles-induced immune suppression predisposes to secondary bacterial and fungal infection.

• First reported series of ECMO for measles: feasible, with 60% survival, but marked by coinfection, cardiac dysfunction, and neurologic injury. • Antifungal prophylaxis at ECMO cannulation was associated with elimination of candidemia in this cohort.