Extracorporeal Membrane Oxygenation to Facilitate Liver Transplantation in a Child with Wilson Disease and Refractory Hypoxemia due to Pulmonary Hemorrhage

Background: Extracorporeal membrane oxygenation (ECMO) is a rescue strategy used in refractory hypoxemia due to varied reversible etiologies.We describe a rare report of its utility to bridge a child with liver failure who had life-threatening pulmonary hemorrhage to a successful liver transplant (LT).Case description: Master S, a 6-year-old school-going boy, was admitted with liver failure and multiorgan dysfunction.He was provisionally diagnosed with Wilson disease (WD), presenting as an acute Wilson crisis along with underlying chronic liver failure.He sustained an episode of lifethreatening pulmonary hemorrhage and had refractory hypoxemia unresponsive to conventional ventilatory strategies.After a multidisciplinary team discussion, a decision to offer venovenous ECMO (VV-ECMO) was taken, and he could be successfully bridged to LT while on ECMO, and subsequently discharged with intact neurological outcome. Conclusion:We report the successful employment of VV-ECMO as a bridge to LT in a child with WD presenting for the first time with acute Wilson crisis.The decision to use ECMO in such a clinical scenario involves a multidisciplinary team discussion involving all the stakeholders and an honest discussion with the family on the expected complications and outcomes.Modifications in the conventional ECMO strategies, preparation for anticipated catastrophic complications in the operative room, and meticulous planning among the ECMO team, perfusionists, intensive care team, anesthetists, and surgeons are of paramount importance in such complex scenarios.