Prolonged venovenous extracorporeal membrane oxygenation in a child with leukemia and persistent bacteremia.

OBJECTIVE

In patients who require extracorporeal membrane oxygenation for prolonged periods, it is uncertain whether nosocomial bacteremia that persists throughout an entire extracorporeal membrane oxygenation run can be associated with good outcomes.

METHODS

Case report.

METHODS

Tertiary pediatric intensive care unit.

METHODS

A 6-yr-old boy with acute myeloid leukemia and prolonged mechanical ventilatory support.

METHODS

Venovenous extracorporeal membrane oxygenation.

RESULTS

The patient required extracorporeal membrane oxygenation for refractory hypoxia secondary to nosocomial pneumonia. On day 2 of the extracorporeal membrane oxygenation run and every day thereafter, blood cultures were consistently positive for Stenotrophomonas maltophilia despite combination therapy with intravenous polymyxin B and cotrimoxazole. Excluding the cannulae, the extracorporeal membrane oxygenation circuit was electively changed once during the run but without any effect on bacteremia. After 38 days of extracorporeal membrane oxygenation, the patient was successfully decannulated and the bacteremia ceased. He remains completely well and disease-free at 6-month follow-up.

CONCLUSIONS

Sustained bacteremia during an extracorporeal membrane oxygenation run should not be regarded as a reason to withdraw extracorporeal support, although efforts are clearly warranted to identify possible sources of sepsis and wean off extracorporeal membrane oxygenation at the earliest opportunity.