Case Reports

Extracorporeal Membrane Oxygenation as a Platform for Recovery: A Case Report of a Child with Pulmonary Hemorrhage, Refractory Hypoxemic Respiratory Failure, and New Onset Goodpasture Syndrome

^* Department of Pediatrics, Division of Pediatric Critical Care, Vanderbilt University School of Medicine, Nashville, Tennessee
^† Department of Pediatrics, Division of Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee
^‡ Department of Pediatrics, Division of Nephrology, Vanderbilt University School of Medicine, Nashville, Tennessee
^§ Vanderbilt University Medical Center, Extracorporeal Membrane Oxygenation Unit, Nashville, Tennessee

Address correspondence to: Abdallah Dalabih, MD, 2200 Children’s Way, 5121 Doctor’s Office Tower, Nashville, TN 37232. E-mail: drdalabih@gmail.com

Received: 4 January 2012
Accepted: 2 April 2012

Abstract

We report a case of a 9-year-old female with acute pulmonary hemorrhage and refractory hypoxemic respiratory failure secondary to Goodpasture syndrome (GS). After failing treatment with high frequency oscillatory ventilation and inhaled nitric oxide, she was successfully managed with venovenous extracorporeal membrane oxygenation (VV ECMO). The patient’s weight at the time of cannulation was 31 kg. A 19 French 18 cm (arterial) Biomedicus cannula was inserted in the right internal jugular vein and used as the drain. A 17 French 50 cm (venous) Biomedicus cannula was inserted in the right femoral vein and used as the return. Then the patient was anticoagulated with 100 units/kg of intravenous heparin and the circuit was primed with one unit of packed red blood cells. VV ECMO was performed with an SIII Sorin roller head pump with integrated servo regulator and a Quadrox D Bioline coated oxygenator. Despite systemic anticoagulation with heparin, the patient’s pulmonary hemorrhage resolved. Extracorporeal membrane oxygenation served as a platform through which we were able to provide renal replacement therapy and plasmapheresis. The patient was successfully discharged home with normal pulmonary function.