Anticoagulation management in a pediatric patient with protein S deficiency and acute pulmonary embolism undergoing ECMO-supported intervention: a case report

Introduction Protein S deficiency is a predominant form of hereditary thrombophilia in Asian populations. Pediatric venous thromboembolism (VTE) is exceedingly rare, with an incidence of only 0.2%–0.6%, and acute massive pulmonary embolism (PE) requiring extracorporeal membrane oxygenation (ECMO) support in children with thrombophilia presents exceptional clinical challenges. The core therapeutic dilemma lies in reconciling the hypercoagulable state inherent to protein S deficiency with the high bleeding risk following thrombolytic therapy, compounded by the obligatory anticoagulation requirement during ECMO. This case report describes the nursing management of a pediatric patient with protein S deficiency and acute PE who successfully underwent ECMO-supported interventional treatment under high bleeding risk. Outcome The patient was successfully weaned from ECMO after 98 h of support, extubated on day 6, and discharged in stable condition after 30 days of hospitalization. At 6-month follow-up, no thrombus recurrence was observed, and the patient had fully resumed normal life and academic activities. Conclusion This case demonstrates that an individualized low-dose heparin anticoagulation strategy, guided by the PEACE consensus and supported by meticulous monitoring, can effectively balance the competing risks of thrombosis and hemorrhage in pediatric ECMO patients with underlying thrombophilia and recent thrombolysis. Notably, as a single case report, this finding cannot be broadly generalized to all pediatric ECMO patients with thrombophilia. Instead, this case provides a potential framework for individualized anticoagulation and nursing management that requires further validation in larger pediatric cohorts. The nursing experience provides a practical reference for managing similar complex cases in pediatric critical care.