Miller Jenna, Orrick Johanna, Holton Caroline, Juang David
Division of Critical Care, Children's Mercy Hospital, Kansas City, MO, USA.
University of Missouri Kansas City, Kansas City, MO, USA.
Arch Clin Cases. 2025 Aug 20;12(3):119-122. doi: 10.22551/2025.48.1203.10323. eCollection 2025.
Extracorporeal membrane oxygenation (ECMO) has historically been avoided in oncological patients due to perceived risks. However, recent literature suggests improved survival rates for pediatric oncology patients. Additionally, necrotizing fasciitis from is associated with high morbidity and mortality, especially in patients with preexisting malignancies. Few studies have explored the outcomes of ECMO in patients with both necrotizing fasciitis and hematologic malignancies. We present a case of a 16-year-old male with pre-B cell acute lymphoblastic leukemia (ALL) and necrotizing fasciitis successfully supported with veno-arterial (VA) ECMO. The patient underwent induction chemotherapy for ALL but developed severe septic shock and necrotizing fasciitis. The patient was deemed an ECMO candidate based on the favorable prognosis of both ALL and necrotizing fasciitis. He underwent ECPR and was cannulated onto VA ECMO. Surgical interventions were performed while on ECMO, including debridement and abdominal wound management. Despite complications such as gastrointestinal bleeding, the patient was successfully decannulated from ECMO after eight days. He recovered well, with no recurrence of bleeding, resumed chemotherapy, and was discharged home on day 54. Follow-up appointments showed remission from ALL and good functional recovery. This case highlights the feasibility and success of ECMO support in an adolescent with both ALL and necrotizing fasciitis. Careful patient selection, multidisciplinary collaboration, and aggressive management of complications are crucial for favorable outcomes in such complex cases. ECMO candidacy should be considered on an individual basis, even in patients with high-risk surgical interventions.
由于存在潜在风险，体外膜肺氧合（ECMO）在肿瘤患者中一直未被采用。然而，最近的文献表明儿科肿瘤患者的生存率有所提高。此外，坏死性筋膜炎的发病率和死亡率很高，尤其是在已有恶性肿瘤的患者中。很少有研究探讨ECMO在患有坏死性筋膜炎和血液系统恶性肿瘤患者中的治疗效果。我们报告一例16岁男性前B细胞急性淋巴细胞白血病（ALL）合并坏死性筋膜炎患者，成功接受静脉-动脉（VA）ECMO支持治疗。该患者接受了ALL诱导化疗，但出现了严重的感染性休克和坏死性筋膜炎。基于ALL和坏死性筋膜炎的良好预后，该患者被认为是ECMO治疗的合适人选。他接受了体外心肺复苏（ECPR）并被插管至VA ECMO。在ECMO支持期间进行了手术干预，包括清创和腹部伤口处理。尽管出现了胃肠道出血等并发症，患者在八天后成功撤机。他恢复良好，未再出血，恢复化疗，并在第54天出院。随访显示ALL缓解且功能恢复良好。该病例突出了ECMO支持在一名患有ALL和坏死性筋膜炎的青少年患者中的可行性和成功性。对于此类复杂病例，仔细的患者选择、多学科协作以及积极处理并发症对于取得良好预后至关重要。即使是需要进行高风险手术干预的患者，也应根据个体情况考虑ECMO治疗的可能性。
