Pulmonary arteriovenous malformations (PAVMs) are rare vascular anomalies that can present with profound hypoxemia in children. While transcatheter embolization is the treatment of choice, extreme hypoxemia may preclude safe intervention. Extracorporeal membrane oxygenation (ECMO) can provide temporary stabilization in such scenarios, though its use as a bridge in pediatric PAVM is seldom reported. We describe a 12-year-old girl with no prior comorbidities who presented with severe hypoxemia refractory to maximal ventilatory support. Imaging revealed multiple bilateral PAVMs. Due to worsening desaturation to 60–70% despite high-flow oxygen and intubation, venovenous ECMO was initiated, resulting in improved oxygenation and hemodynamic stability. Once stabilized, she underwent successful staged transcatheter embolization using multiple vascular plugs. ECMO was weaned within 12 hours post-procedure, and the patient was extubated the following day. At follow-up, she remained stable with oxygen saturations of 88–90% on room air and no sequelae from ECMO. This case highlights ECMO as a life-saving bridge to intervention in pediatric PAVM with refractory hypoxemia. Multidisciplinary coordination enabled safe transport, comprehensive imaging, and definitive embolization. Literature review confirms that pediatric reports of ECMO use in PAVM are scarce, with most confined to infancy. Our case underscores the role of ECMO in expanding therapeutic options for older children with severe shunt physiology. In children with life-threatening PAVM and critical hypoxemia, ECMO should be considered as a bridging strategy to transcatheter embolization. Early recognition and coordinated multidisciplinary management are essential for favorable outcomes.
Alzaid et al. (Thu,) studied this question.