35: Journey of a braveheart kid on multiple ECMO runs for post viral pneumonia.

Introduction: A 4-year-old patient referred with severe respiratory failure secondary to viral pneumonia developed bilateral pneumothorax post intubation and ventilation. Case Presentations: Multisite VV ECMO was established with 19Fr RIJV access and 19Fr FV return. Circuit was changed due to clot burden on 15th day of VV ECMO. On 31st Day of ECMO, the kid had sudden cardiovascular collapse requiring CPR and high inotropes which led to conversion of VV to peripheral VVA ECMO with distal limb perfusion to maintain the cardiac instability. After a week of complete cardiac recovery, the arterial limb was removed and multisite VV was continued for significant air leak and hypercapnia. On 42nd day of ECMO, Broncho Pleural Fistula repair and resection of left lower lobe of the left lung was done and on 49th day, kid had cardiac instability and VV ECMO was converted to VVA ECMO. Circuit was changed again on 54th day of ECMO due to rising LDH and clot burden. VVA ECMO was converted to VV ECMO again on 57th day with mild inotropic supports. Results: On 58th day on ECMO, High Frequency Oscillation (HFO) settings and Prone ventilation was carried out for lung recruitment. Repeated bronchoscopies were carried out to remove clots from the left and right bronchus. Patient showed improvement in lung opacification and better ventilator parameters and trial off for ECMO was started over 24 Hours. Continued HFO and trial off tolerated well for more than 24 Hours and was decannulated. Conclusion: This patient had to undergo a long haul nearly 4 months in the intensive care unit because of the pathological condition. With a holistic approach, the multidisciplinary team successfully managed two VV to VA conversions and four ECMO circuit changes and the brave heart was discharged in a stable condition.