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Recovery from Total Acute Lung Failure After 20 Months of Extracorporeal Life Support

Nelson-McMillan, Kristen*,†,‡; Vricella, Luca A.*,¶; Stewart, Dylan*,¶,‖; Young, John**; Shah, Ashish S.††; Hibino, Narutoshi*,¶,#; Coulson, John D.*,‡,§

doi: 10.1097/MAT.0000000000000990
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Since the first successful case report in 1972, extracorporeal life support or extracorporeal membrane oxygenation (ECMO) has become a standard approach for severe respiratory failure unresponsive to other therapy. In the past, if there was no recovery by approximately 30 days or if right ventricular heart failure occurred, ECMO was discontinued and the patient died. More recently patients with severe lung disease have been maintained for months, as opposed to days, with eventual decannulation and recovery. We report the case of a child, 7 years old, with severe inhalational burn injury and rapid progression to multisystem organ failure. She was supported by ECMO with no lung function for almost 2 years. CNS function remained normal and lung function recovered. This is the longest successful case of ECMO to date and prompts further discussion regarding “irreversible” lung injury.

From the *Johns Hopkins University School of Medicine, Baltimore, Maryland

Department of Anesthesiology and Critical Care Medicine, Division of Pediatric Critical Care

Department of Pediatrics

§Division of Pediatric Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland

Department of Surgery, Hopkins University School of Medicine, Baltimore, Maryland

Division of Pediatric General Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland

#Division of Pediatric Cardiothoracic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland

**Department of Pediatric ECMO and VAD program, Johns Hopkins Hospital, Baltimore, Maryland

††Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.

Submitted for consideration March 2018; accepted for publication in revised form August 2018.

Disclosure: The authors have no conflicts of interest to report.

Correspondence: Kristen Nelson McMillan, Johns Hopkins Children’s Center, 1800 Orleans St, Suite 6349 F, Baltimore, MD 21287. Email: knelso23@jhmi.edu.

Copyright © 2019 by the American Society for Artificial Internal Organs