Case Report: Successful Use of Extracorporeal Therapies After ECMO Resuscitation in a Pediatric Kidney Transplant Recipient

Abstract

The combination of extracorporeal membrane oxygenation (ECMO) and extracorporeal blood purification in children is rarely used due to small total blood volumes, risks of hemodynamic instability and a negative association between volume of blood transfusion and patient outcome. To our knowledge, this is the first description of a multimodal extracorporeal detoxication in the setting of ECMO in a post-kidney-transplant child on immunosuppression. We describe a case of a 30-months old child, who was extracorporeally resuscitated after cardiac arrest during kidney transplantation surgery and additionally treated with a number of extracorporeal blood purification methods (plasma exchange, CytoSorb, and lipopolysaccharide adsorption) in the setting of immunosuppression therapy. This case report shows the successful use of multimodal extracorporeal therapies for a good patient outcome. The lack of response to CytoSorb therapy might suggest an occult infection and not necessarily failure of treatment.

Keywords: CytoSorb; ECMO; cardiac arrest; immunosuppression; kidney transplantation; lipopolysaccharide adsorption; plasma exchange.

Figure 1

The extracorporeal circuit illustration and the patient 1 year post-surgery. (A) The CRRT machine arterial line—to the ECMO system venous line. (B) The CRRT machine venous line—to the air trap of the ECMO oxygenator. (C) The CytoSorb adsorber installed pre-filter into the CRRT circuit. (D) PMX-20R column installed later in the same position—pre-filter in the CRRT circuit. (E) Pediatric hemofilter in the CRRT circuit. (F) The patient 1 year post-surgery.