Against All Odds: A Case of Pediatric Acute Respiratory Distress Syndrome Requiring 233 Days of Extracorporeal Membrane Oxygenation Support.

Extracorporeal membrane oxygenation (ECMO) has been used to support children with pediatric acute respiratory distress syndrome (PARDS) who fail to respond to conventional management strategies. There is limited literature and guidance on long-term ECMO support for severe PARDS and its impact on lung recovery. We present a case of a 4 month old female who developed severe necrotizing pneumonia following respiratory syncytial virus (RSV) infection. She had subsequent cardiogenic shock and deterioration of lung function, initially requiring venoarterial (VA) ECMO cannulation. She had improvement in cardiac function but developed large pneumatoceles with minimal functional lung tissue, prompting transition to venovenous (VV) ECMO via a right atrial double-lumen cannula and later multisite VV ECMO when she outgrew her previous cannulation. Nitric oxide was added to the sweep gas (sNO) to preserve the membrane oxygenator, extending the life of one oxygenator to over 5 months. The massive bilateral pneumatoceles regressed over time, and the compressed normal lung tissue recovered, allowing her to be weaned off ECMO support and decannulated after 233 days. She underwent tracheostomy decannulation and was discharged home on room air after nearly 10 months in the hospital.