Management of severe pulmonary hemorrhage in a neonate on veno-arterial ECMO by the temporary clamping of the endotracheal tube – a case report

Author:

Vobruba Vaclav1,Grus Tomas2,Mlejnsky Frantisek2,Belohlavek Jan3,Hridel Jan1,Lambert Lukas4

Affiliation:

1. Department of Pediatrics and Adolescent Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic

2. Department of Cardiovascular Surgery, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic

3. Second Department of Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic

4. Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic

Abstract

Severe pulmonary hemorrhage in the newborn is an infrequent, but life-threatening, event. A newborn with persistent pulmonary hypertension and a large persistent ductus arteriosus and open foramen ovale presented with hypoxemia and progressive right heart failure shortly after birth, requiring veno-arterial extracorporeal membrane oxygenation (ECMO) support. Twenty minutes after the initiation of ECMO, the patient developed severe pulmonary hemorrhage refractory to conventional treatment. As a last resort, the endotracheal tube was clamped. After transport to the ECMO center, repeated attempts to open the endotracheal tube resulted in continued blood loss and the endotracheal tube was clamped for a total of 63 hours without any mechanical ventilation. On the third postnatal day, the endotracheal tube was reopened, large amounts of clot were removed by bronchoscopy and mechanical ventilation was resumed followed by improved general condition and favorable outcome.

Publisher

SAGE Publications

Subject

Advanced and Specialised Nursing,Cardiology and Cardiovascular Medicine,Safety Research,Radiology Nuclear Medicine and imaging,General Medicine

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