ABSTRACT
Since the first successful case report in 1972, extracorporeal life support or extracorporeal membrane oxygenation (ECMO) has become a standard approach for severe respiratory failure unresponsive to other therapy. In the past, if there was no recovery by approximately 30 days or if right ventricular heart failure occurred, ECMO was discontinued and the patient died. More recently patients with severe lung disease have been maintained for months, as opposed to days, with eventual decannulation and recovery. We report the case of a child, 7 years old, with severe inhalational burn injury and rapid progression to multisystem organ failure. She was supported by ECMO with no lung function for almost 2 years. Central nervous system function remained normal and lung function recovered. This is the longest successful case of ECMO to date and prompts further discussion regarding "irreversible" lung injury.
Subject(s)
Burns, Inhalation/therapy , Extracorporeal Membrane Oxygenation/methods , Recovery of Function , Respiratory Insufficiency/therapy , Burns, Inhalation/complications , Child , Female , Humans , Respiratory Insufficiency/etiology , Time FactorsABSTRACT
We describe the management of posterior trachea tears after blunt neck trauma in two children. The first, a 5 year-old boy who fell off his scooter, causing a 1.0cm tear in the membranous cervical trachea, was managed conservatively with 5 days of intubation. The second, a 12 year-old girl who fell on her bicycle, causing a 4.0cm tear in the membranous thoracic trachea, was repaired with thoracoscopic techniques. The presumed mechanism may be expansion of the U-shaped cartilage with tear of the membranous trachea. The size, location, and severity of symptoms dictate the decision about primary repair versus conservative management.
