TITLE:
Veno-Venous Extra-Corporeal Membrane Oxygenation (ECMO) in a Child with Hemoptysis and Fontan Circulation
AUTHORS:
Claudine Kumba, Gauthier Loron, Anais Mons, Claude Marcus, Francis Grossenbacher, Nathalie Bednarek-Weirauch, Vito Giovanni Ruggieri, Emre Belli, Jean-Marc Malinovsky, Pierre Mauran
KEYWORDS:
Extracorporeal Membrane Oxygenation, Fontan Circulation, Univentricular Heart, Tricuspid Atresia, Children, One Lung Ventilation, Mobile ECMO Team, Pediatric Anesthesia and Critical Care, Angio-Embolization, Interventional Radiology, Pediatric Cardiology, Pediatric Cardiac Surgery, Trans-Thoracic Echocardiography Aortic Velocity Time Integral, Fluid Responsiveness, Goal Directed Fluid and Hemodynamic Therapy
JOURNAL NAME:
Open Journal of Pediatrics,
Vol.10 No.2,
May
20,
2020
ABSTRACT: Background: Extracorporeal membrane oxygenation is a rescue life support
technique used in life threatening conditions of refractory respiratory and/or cardiac
distress. Indication for extracorporeal life support in children depends on age and varies
from pulmonary to cardiac pathologies. In some cases, it may be used as a bridge to a therapeutic procedure. We described here the
management of respiratory failure due to hemoptysis in a child with a Fontan
circulation and
veno-venous extracorporeal membrane oxygenation which served as a bridge to
angio-embolization. Hemoptysis can be a life threatening condition which can
lead to hypovolemic shock and impaired alveolar gas exchange. The latter can result in respiratory
failure and consequent asphyxia. When hemoptysis occurs in a patient with a
univentricular heart
and a Fontan circulation, management of this clinical situation can be challenging due to the
particular physiology of the latter. Total cavopulmonary connection is a
palliative surgical repair which constitutes Fontan circulation as a definitive
treatment in patients with a univentricular heart. Methods: Case report
description of a 16 year-old boy with a univentricular heart and a Fontan
circulation who
presented hemoptysis managed with a veno-venous extracorporeal membrane
oxygenation (ECMO) as a bridge
to angio-embolization. Results: Hemoptysis due to diffuse intra-alveolar
hemorrhage from collateral circulation was successfully treated in this young patient with
pulmonary vascular embolization. This allowed to wean the patient from extra-corporeal membrane oxygenation. Conclusion: Veno-venous ECMO can be life-saving as a bridge to
angio-embolization for severe hemoptysis in patients with Fontan circulation. The reported case
allows to underline that our
multidisciplinary approach in this complex pediatric patient
surely participated to improve outcome.