Abstract
We report the case of a 6-year-old boy with fulminant myocarditis rescued by intensive care involving veno arterial extracorporeal membrane oxygenation (VA-ECMO). He had a history of fulminant myocarditis 4 years earlier. A few hours after admission, his condition deteriorated rapidly, and he developed severe cardiopulmonary failure. At that time, we rapidly introduced VA-ECMO because it was possible to quickly replace the 10 Fr ECMO artery cannula using a 4 Fr catheter, which had been previously inserted into the femoral artery. In pediatric cases, if the patient weighs <25 kg, the carotid artery approach is commonly used for VA-ECMO. In this case, the patient had not been intubated, and we therefore selected the femoral artery because of its location and ease of access. However, lower extremity ischemia is frequently seen in pediatric cases treated using the femoral artery. We therefore tried to prevent lower extremity ischemia by compulsory retrograde blood perfusion via the dorsal artery. This case report describes our efforts to rapidly introduce VA-ECMO while preventing lower extremity ischemia.
