Intrapleural fibrinolysis during pediatric extracorporeal life support.

Pediatric patients who require extracorporeal life support (ECLS) for refractory cardiorespiratory failure are at increased risk for intrapleural hemorrhage due to the effects of systemic anticoagulation and frequent occurrence of pneumothorax. Surgical evacuation is standard therapy for retained hemothorax to prevent secondary empyema, pulmonary compression, and development of fibrothorax. However, surgical interventions during ECLS are hazardous and place patients at increased risk for surgical site bleeding. Intrapleural fibrinolysis with tissue plasminogen activator may be used to facilitate nonsurgical evacuation of retained hemothorax. We present two pediatric patients who were safely and successfully managed with intrapleural fibrinolysis of retained hemothorax during ECLS.