Successful Use of Anticoagulation-free Prolonged Extracorporeal Membrane Oxygenation for Massive Pulmonary Hemorrhage in a Child with Heart Transplant and Mechanical Mitral Valve: A Case Report with Review of Literature

Abstract

Background: Pulmonary hemorrhage is a rare cause of morbidity and mortality in children. Extracorporeal membrane oxygenation (ECMO) can be used as a rescue mode of support in children with life-threatening respiratory failure. However, the dilemma arises as to how to balance anticoagulation to prevent circuit thrombosis while avoiding bleeding complications or worsening hemorrhage. Clinical Description: We present an adolescent with a history of Noonan syndrome, orthotopic heart transplant, and mechanic mitral valve that required emergent veno-venous (VV) ECMO support due to life-threatening hypoxia related to severe pulmonary hemorrhage secondary to anticoagulation for his prosthetic mitral valve. Management and Outcome: The patient remained on ECMO for 28 days with no anticoagulation and did not receive any anticoagulant or antiplatelet agents postdecannulation for 4 months despite the presence of a mechanical valve. No thrombotic complications to the mechanical valve or the ECMO circuit occurred. Conclusion: Prolonged anticoagulation-free VV-ECMO support may be used as a rescue strategy in patients with massive pulmonary hemorrhage resulting in refractory respiratory failure.