Successful venoarterial extracorporeal membrane oxygenation support for septic shock in a child with relapsed acute myeloid leukemia and complete superior vena cava obstruction: a case report

Extracorporeal membrane oxygenation (ECMO) in pediatric oncology patients remains controversial because of historically poor outcomes and persistent concerns regarding severe infection, bleeding, and immune suppression.We describe a 2-year-old boy with relapsed acute myeloid leukemia who developed profound septic shock and acute respiratory distress syndrome following surgical debridement of a necrotizing perineal infection.The patient had previously experienced tumor lysis syndrome requiring continuous renal replacement therapy, which resulted in complete superior vena cava obstruction.This anatomic limitation precluded conventional internal jugular venous cannulation, and appropriately sized peripheral femoral venous cannulas were not available at the time ECMO was required.Venoarterial ECMO was therefore initiated using direct inferior vena cava cannulation.Hemodynamic stabilization and pulmonary improvement occurred promptly, allowing ECMO decannulation after 8 days and extubation on the following day.The patient ultimately achieved full clinical recovery, with complete wound healing, and remained in complete remission at 9.4 years of follow-up.This case illustrates that ECMO may be lifesaving in carefully selected pediatric oncology patients when the acute illness is reversible and the underlying malignancy is controlled.It further emphasizes the importance of individualized cannulation strategies in the setting of central venous obstruction.