Case Report
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World J Clin Cases. Oct 16, 2014; 2(10): 578-580
Published online Oct 16, 2014. doi: 10.12998/wjcc.v2.i10.578
Challenging rescue of a 4 years old boy with H1N1 infection by extracorporeal membrane oxygenator: A case report
Nestoras Papadopoulos, Sven Martens, Harald Keller, Ali El-Sayed Ahmad, Anton Moritz, Andreas Zierer
Nestoras Papadopoulos, Harald Keller, Ali El-Sayed Ahmad, Anton Moritz, Andreas Zierer, Division of Thoracic and Cardiovascular Surgery, Johann-Wolfgang-Goethe University, 60590 Frankfurt/Main, Germany
Sven Martens, Division of Thoracic and Cardiovascular Surgery, University Hospital Muenster, 48419 Muenster, Germany
Author contributions: Martens S performed the ECMO implantation; Keller H was the perfusionist; El-Sayed Ahmad A performed data analysis; Papadopoulos N, Moritz A and Zierer A were the major contributors in writing the manuscript; all authors read and approved the final manuscript.
Correspondence to: Nestoras Papadopoulos, MD, Division of Thoracic and Cardiovascular Surgery, Johann-Wolfgang-Goethe University, Theodor Stern Kai 7, 60590 Frankfurt/Main, Germany. nestoras.papadopoulos@gmail.com
Telephone: + 49-69-630183601 Fax: + 49-69-63017582
Received: April 4, 2014
Revised: June 23, 2014
Accepted: July 27, 2014
Published online: October 16, 2014
Abstract

Introduction: World Health Organization announced on April 2009 a public health emergency of international concern caused by swine-origin influenza A (H1N1) virus. Acute respiratory distress syndrome (ARDS) has been reported to be the most devastating complications of this pathogen. Extracorporeal membrane oxygenator (ECMO) therapy for patients with H1N1 related ARDS has been described once all other therapeutic options have been exhausted. Here, we report the case of a child (German, male) with H1N1-associated fulminate respiratory and secondary hemodynamic deterioration who was rescued by initial emergent ECMO established through a dialysis catheter and subsequent switch to central cannulation following median sternotomy. This report highlights several important issues. First, it describes a successful use of a dialysis catheter for the establishment of a veno-venous ECMO in an emergency case by child. Second, it highlights the importance of a closely monitoring of clotting parameters during ECMO therapy and third, if severe respiratory failure is complicated by cardiogenic shock, veno-atrial ECMO support via median sternotomy should be considered as a viable treatment option without further delay.

Keywords: Airway, Circulatory temporary support, Coagulants, Extracorporeal membrane oxygenation, Infection

Core tip: Here, we report the case of a child with swine-origin influenza A-associated fulminate respiratory and secondary hemodynamic deterioration, who was rescued by initial emergent extracorporeal membrane oxygenator (ECMO) established through a dialysis catheter and subsequent switch to veno-atrial ECMO (VA-ECMO) via central cannulation. This report highlights several important issues. First, it describes a successful use of a dialysis catheter for the veno-venous ECMO-establishment in an emergency case by child. Second, it highlights the importance of a closely monitoring of clotting parameters and third, if severe respiratory failure is complicated by cardiogenic shock, VA-ECMO support via median sternotomy should be considered as a viable treatment option without further delay.