Veno-venous ECMO with Bicaval Cannula for Refractory Hypoxemia in a Child

Acute respiratory distress syndrome (ARDS) due to viral or bacterial lower respiratory tract infections is a common indication for mechanical ventilatory support in children.Common viruses involved include Influenza A or B, Parainfluenza, Adenovirus, Coronavirus, and Measles.While the standard respiratory support for pediatric ARDS (pARDS) includes conventional ventilatory support along with non-ventilatory measures, a minority of patients develop refractory hypoxemia and warrant higher forms of ventilation like high-frequency oscillatory ventilation (HFOV) and occasionally extracorporeal membranous oxygenation (ECMO).Extracorporeal life support organization (ELSO) guidelines have recommended the use of ECMO in reversible refractory hypoxemia.Here, we describe a toddler with severe ARDS and air leak, who was managed with venovenous ECMO (VV ECMO) and bronchoscopy toilets.