What question did this study set out to answer?

To evaluate the effectiveness of inhaled nitric oxide in treating hypoxemia due to right heart failure during V-V ECMO.

June 12, 2026

ID:112 FC-D03-6 A case of refractory hypoxemia due to right heart failure during V-V ECMO for severe chest trauma treated with inhaled nitric oxide

SMSoshi MiyamotoIchinomiya Kenshin College KKKenji KawadeIchinomiya Kenshin College THTakafumi HibinoIchinomiya Kenshin College

Key Points

To evaluate the effectiveness of inhaled nitric oxide in treating hypoxemia due to right heart failure during V-V ECMO.
Reported case of a 14-year-old male with severe chest trauma and respiratory failure treated with V-V ECMO and iNO therapy.
Transthoracic echocardiography was used to assess right ventricular dilation and tricuspid regurgitation.
Patient monitoring included oxygenation and hypercapnia levels pre- and post-iNO administration.
After iNO therapy initiation, patient oxygenation improved with significant decreases in hypercapnia.
Right ventricular dilation and tricuspid regurgitation resolved within 24 hours of iNO treatment.
Patient was extubated on day 8 and discharged from ICU on day 11.

Abstract

Background: V-V ECMO is a treatment option for respiratory failure due to severe chest trauma and pulmonary contusion. Inhaled nitric oxide (iNO) improves oxygenation by reducing pulmonary artery pressure and correcting ventilation–perfusion mismatch. We report a case in which iNO was used because V-V ECMO for hypoxemia due to severe chest trauma and pulmonary contusion was insufficient owing to pulmonary hypertension and right heart failure. Clinical Course: A 14-year-old healthy male was admitted after a motor vehicle accident with hemorrhagic shock and respiratory failure due to pulmonary contusion and alveolar hemorrhage. Persistent hypoxemia and hypercapnia required initiation of V-V ECMO, but gas exchange did not improve. Transthoracic echocardiography showed right ventricular dilation and severe tricuspid regurgitation. We considered pulmonary hypertension and right heart failure to be caused by hypoxemia and hypercapnia due to pulmonary contusion and alveolar hemorrhage. The ECMO drainage oxygen saturation was 94%, suggesting recirculation, with right heart failure as the primary contributor. Because ongoing airway bleeding made conversion to V-A ECMO high risk, iNO therapy was initiated. Oxygenation and hypercapnia improved, and right ventricular dilation and tricuspid regurgitation resolved within 24 hours. V-V ECMO was discontinued on day 7, iNO was stopped and the patient was extubated on day 8, discharged from the ICU on day 11, and discharged ambulatory on day 98. Discussion: Severe respiratory failure requiring V-V ECMO is often complicated by right heart failure, necessitating conversion to V-A ECMO. In trauma cases, however, this carries a risk of arterial bleeding due to anticoagulation. The use of iNO may have alleviated right heart failure, thereby reducing recirculation. Conclusion: This case demonstrates that iNO is an effective option for hypoxemia and pulmonary hypertension complicating V-V ECMO in severe chest trauma. iNO may be considered before conversion to V-A ECMO in patients at risk of bleeding

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