2021 Volume 28 Issue 2 Pages 105-109
We report herein a case of 47-day-old male patient with critical pertussis and pulmonary hypertension treated by long-term extracorporeal membrane oxygenation (ECMO). After the onset of severe respiratory distress caused by pertussis, leukodepletion was performed on the day 10 of illness before obvious pulmonary hypertension developed. However, on day 12 of illness, his pulmonary hypertension became obvious and compromised his systemic circulation. Veno arterial-ECMO (VA-ECMO) was therefore begun on day 12 of illness. The ECMO configuration mode was switched from VA to veno-veno arterial (V-VA) on day 32 of illness to assess the safety of weaning, and balloon atrial septostomy (BAS) was done on day 35 of illness to maintain systemic blood flow. The patient received aggressive physiotherapy and repetitive bronchoscopic suctioning thereafter. He was weaned from ECMO support on the day 45 of illness, 34 days after the initiation of ECMO. He was discharged from the hospital without neurocognitive or respiratory sequelae on day 124. His cardiac catheterization after one year revealed no pulmonary hypertension. Long-term ECMO with careful assessment and aggressive management, including V-VA ECMO and BAS, is a potential therapeutic option for critical pertussis in infants with the complication of severe pulmonary hypertension.
