34: Extracorporeal Membrane Oxygenation (ECMO) as a Bridge to Recovery in Children with Severe Necrotizing Pneumonia: Case Report

Introduction: Necrotizing pneumonia is a severe complication of bacterial or viral pneumonia that can lead to refractory respiratory failure in children. Extracorporeal membrane oxygenation (ECMO) has emerged as a vital rescue therapy when conventional treatments fail. We describe the successful use of venovenous ECMO (VV-ECMO) in two pediatric patients diagnosed with severe necrotizing pneumonia. Case Presentations: The first patient, a 2-year-old boy, developed necrotizing pneumonia caused by parainfluenza 3 virus. He required 7 days of VV-ECMO support for refractory hypoxic hypercapnic respiratory failure. He was decannulated then extubated on day 14 of his illness. The second patient, a 5-year-old girl, was diagnosed with necrotizing pneumonia caused by Streptococcus pneumoniae and Rhinovirus. She had a complex course with computed tomography (CT) imaging revealing extensive bilateral lung pathology, including loculated pleural effusions, pneumothoraces and a suspected bronchopleural fistula. This patient also experienced ECMO related complications, including drainage insufficiency, circuit clot formation, and neurological issues She required 30 days of VV-ECMO support and was decannulated and extubated on day 40 of her illness. Conclusion: VV-ECMO use as a bridge to recovery is expanding, with increasing survival rates across various indications among children, including severe necrotizing pneumonia. ECMO support duration varies, with longer support associated with higher complication risks. ECMO is crucial for recovery and preventing further injury. Despite these challenges, both patients achieved lung recovery, reduced mechanical ventilation needs, and survived to discharge. Clinical presentation, disease course, and patient response variability significantly influence ECMO duration and outcomes. Early ECMO initiation, lung rest, and targeted antibiotic therapy for active infection are crucial to better outcomes.