High frequency oscillatory ventilation as a bridge from extracorporeal membrane oxygenation in pediatric respiratory failure

Mortality due to severe respiratory failure remains high in infants and children. Extreme measures are sometimes required to sustain life. We report the cases of 2 children who had prolonged courses of extracorporeal membrane oxygenation (ECMO) in whom high-frequency oscillatory ventilation (HFOV) was used as a bridge from ECMO to conventional ventilation (CV). Patient A had severe respiratory failure following a viral infection and had been treated with venoarterial ECMO for > 23 days. A trial of CV was not successful. HFOV was instituted and continued for 14 days, after which she was successfully maintained on CV until extubation. Patient B developed respiratory failure as a consequence of multiple trauma sustained in a motor vehicle accident. She required ECMO for 19 days and, like Patient A, failed a trial on CV. HFOV was started and maintained for 24 days after which, the patient tolerated CV well until extubation. Neither patient had neurologic or respiratory morbidity. Although these data are uncontrolled, clearly, patients on ECMO for whom decannulation is imperative, may be safely managed using HFOV as a bridge to CV and extubation.