Extracorporeal membrane oxygenation as apre-transplant rescue therapy in a patient with anoncohematological condition

The use of extracorporeal membrane oxygenation (ECMO) in pediatrics poses a significant clinical and ethical challenges due to its high costs and associated morbidity and mortality. We present the case of a 2-year-old boy with severe bone marrow aplasia and septic shock who required ECMO as a bridge to hematopoietic stem cell transplantation. High-flow venoarterial support was initiated, initially without anticoagulation, due to marked thrombocytopenia and a high risk of bleeding. A multidisciplinary discussion was held involving the treating medical team and the institutional Ethics Committee. The patient was successfully weaned from support, showed favorable clinical progress until receiving the transplant, and achieved effective hematopoietic recovery. This case illustrates the complexity of decision-making regarding ECMO use in oncohematological patients, highlighting the importance of individualized assessment, family involvement, and the need to avoid futile therapeutic intervention.