The Anterior Mediastinal Mass—the Challenging Management of Hypoxemia Despite Peripheral Cannulation for ECMO

Mediastinal lymphoblastoma presenting as wheezing in a child

“…Mediastinal tumors in children may grow rapidly and can cause severe airway obstruction 1 which is associated with mortality and morbidity 2 . Lymphomas are accounting for approximately 46%–56% of all mediastinal masses, 3 and approximately 50%–70% of children with lymphoblastic lymphoma present with an anterior mediastinal mass 4,5 .…”

“…Mediastinal tumors in children may grow rapidly and can cause severe airway obstruction 1 which is associated with mortality and morbidity. 2 Lymphomas are accounting for approximately 46%-56% of all mediastinal masses, 3 and approximately 50%-70% of children with lymphoblastic lymphoma present with an anterior mediastinal mass. 4,5 This case shows that mediastinal lymphomas should not be overlooked, avoiding false or missed diagnoses in children who develop gradual aggravation or sudden fetal danger.…”

Echocardiography for extracorporeal membrane oxygenation

“…71 Patients requiring ECMO universally undergo lung protective ventilation, however, if lung function is poor and there is sufficient native left ventricular function present, blood ejected from the left ventricle across the aortic valve can be poorly oxygenated. 72 This poorly oxygenated blood will eventually encounter the well oxygenated arterial ECMO blood from the femoral cannula and result in hypoxemic blood delivery to the aortic root and arch vessels. 73 Color flow Doppler in the descending aorta can determine mixing of VA ECMO support and native cardiac output, and the level at which mixing occurs can be indicative of cardiac recovery and weaning progress.…”