Pediatric Acute Respiratory Distress Syndrome and Tracheal Injury in a Patient Requiring Extracorporeal Membrane Oxygenation Following Cement Aspiration: A Case Report

Abstract

Background: Ingestion and aspiration of caustic substances is a common problem in pediatrics and carries the risk of associated aspiration pneumonitis, laryngeal injury, and esophageal injury. Extracorporeal membrane oxygenation (ECMO) has been used to support adults with acute respiratory distress syndrome (ARDS) from aspiration of cement dust, however, literature outlining pediatric management in cases of alkali lung and airway injuries is lacking.

Case summary: A 6-year-old boy presented with ARDS from cement aspiration requiring high-pressure ventilation. He had further complications of tracheal injury with subsequent pneumomediastinum secondary to the alkali burn. He required ECMO to facilitate repeat bronchoscopy for cement particle washout and to enable recovery from ARDS and tracheal injury.

Conclusion: This case highlights the need to perform early bronchoscopy and gastrointestinal endoscopy for injury assessment and foreign body removal in alkali burns. It also emphasizes the value of ECMO support for respiratory failure and facilitating bronchoalveolar lavage when it is not otherwise tolerated.

Keywords: acute respiratory distress syndrome; alkali; cement; extracorporeal membrane oxygenation; pediatric.

Figure 1.

Timeline of events. HFOV = high-frequency oscillation ventilation, VA-ECMO = venoarterial extracorporeal mechanical oxygenation, VV-ECMO = venovenous extracorporeal mechanical oxygenation.

Figure 2.

Unenhanced CT of the chest, abdomen, and pelvis was performed 3 days after injury, windowed to accentuate abnormal findings. A, Axial image through the upper chest shows the large full-thickness defect (open arrows) in the right posterolateral wall of the midthoracic trachea (T) with tracheal air tracking into the adjacent mediastinal soft tissues. B, Sagittal image through the left hemithorax shows aspirated cement concretions as linear hyperdense casts filling the airways of the right middle and lower lobes (dashed circle), with partial left lower lobe collapse. Globular collection of similarly hyperdense material settled dependently in the gastric fundus represents the cement slurry in the stomach (solid circle).

Figure 3.

Initial bedside bronchoscopy showed mucosal injury.