J Extra Corpor Technol 2025 , 57 , 42 – 49 Ó The Author ( s ), published by EDP Sciences , 2025 https :// doi . org / 10.1051 / ject / 2025004
Available online at : ject . edpsciences . org
CASE REPORT
Prolonged ECMO support in a pediatric patient with complex cardiac conditions during wartime in Kyiv , Ukraine
Daniel Rusnak MD 1 , Ignazio Condello PhD 2 ,* , Valerii Dohtiar MD 1 , Serhii Varbanets MD 1 , Kristina Alieksieieva MD 1 , Serhii Luhovkin MD 1 , Vladyslav Palokha MD 1 , Vadym Zhoha MD 1 , Neonila Bukhnei MD 1 , Lesia Krashevska MD 1 , Olha Kutsenko MD 1 , Nataliia Kupina MD 1 , and Oleksii Vnukov MD 1
1 The Scientific and Practical Medical Center of Pediatric Cardiology and Cardiac Surgery of the Ministry of Health of Ukraine , Rbїd , dуk . В ' z [ есkаdа Xорyоdоkа 28 / 1 2 Department of Cardiac Surgery , Anthea Hospital , GVM Care & Research , Via Camillo Rosalba 35 / 37 , 70124 Bari , Italy
Received 25 November 2024 , Accepted 22 January 2025
Abstract – Background : In the conflict-affected setting of Kyiv , Ukraine , managing complex medical interventions presents significant challenges , especially for critically ill pediatric patients . This case report describes the prolonged use of extracorporeal membrane oxygenation ( ECMO ) in a 12-year-old girl with severe congenital heart disease , including critical aortic stenosis and myocarditis . In the absence of a transplant system and with limited resources , alternative solutions were explored to balance the high risk of complications and maintain ECMO support over an extended period . Methods : The patient received ECMO support for a total of 259 days , utilizing both VV-ECMO and VA-ECMO configurations . Due to wartime supply issues , polypropylene fiber oxygenators , specifically the Quadrox-i and Terumo Fx15 models , were used despite not being indicated for long-term use . Eleven oxygenators were employed , with a total of ten replacements due to thrombosis and technical malfunctions . Oxygenator models included EUROSETS Alone , Maquet PLS , Paragon , Terumo Fx15 , and Quadrox-i . Frequent adjustments to ECMO parameters , infection control , and daily rehabilitation efforts were essential components of care . Weaning tests consistently indicated no recovery of cardiac function . Results : Despite rigorous management , the oxygenators faced performance declines over time , including clotting , reduced oxygen exchange , and lower CO 2 removal efficiency , necessitating frequent replacements , with a total of ten changes across the ECMO course . Oxygenator usage durations were as follows : EUROSETS ( 10 , 32 , 88 , and 26 days ), Paragon ( 78 days ), Maquet PLS ( 14 days ), Terumo Fx15 ( 5 , 1 , 3 , and 2 days ), and Quadrox-i ( 1 day ). Notably , EUROSETS nr 3 achieved the longest duration of 88 days , while the Paragon oxygenator provided stable support for 78 days . In contrast , the Maquet PLS oxygenator lasted 14 days , and the Terumo Fx15 and Quadrox-i models required rapid replacement within 1 – 5 days due to accelerated wear and reduced efficacy . Ultimately , ECMO support was discontinued due to irreversible heart failure , with limited options for heart-lung transplantation in Ukraine ’ s conflict-impacted healthcare system . The patient passed away following the cessation of ECMO support due to severe multi-organ dysfunction and complications . Conclusions : This case underscores the extraordinary challenges of prolonged ECMO use in a pediatric patient within a war zone , highlighting the resilience and adaptability required of healthcare teams in resource-limited settings . The logistical constraints imposed by a lack of suitable biomedical devices and the necessity to use suboptimal models due to supply shortages emphasize the need for international support and resource mobilization to sustain advanced medical care in conflict-affected regions .
Key words : Extracorporeal membrane oxygenation ( ECMO ), Pediatric critical care , Prolonged ECMO support , Congenital heart disease , Aortic stenosis , Myocarditis , Conflict zone healthcare , Polypropylene Oxygenators , Oxygenator failure , Resource-limited settings , Organ transplantation barriers , War-affected medical care , ECMO complications , Supply chain limitations , Cardiopulmonary support .
Background
The ongoing war in Ukraine has caused severe and widespread disruption to healthcare systems , particularly in heavily
* Corresponding author : ignicondello @ hotmail . it affected areas such as Kyiv . Healthcare facilities , already strained by the high demand for trauma care , face drastic shortages of essential medical supplies , equipment , and skilled personnel [ 1 ]. In this conflict-driven context , hospitals are often forced to function with limited resources , as supply chains for critical medical equipment are severely hampered by barriers
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