ArticleFrontiers in medicine2026
Severe hyperbilirubinemia secondary to ECMO in a ARDS patient: a case report.
Article in Frontiers in medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
History: A 51-year-old male presented with a 9-day history of fever and cough, progressing to severe respiratory failure refractory to conventional management. Diagnostic methods: High-throughput sequencing confirmed influenza A virus. Chest CT revealed bilateral pneumonia and pulmonary edema. Due to a persistently low oxygenation index (PaO₂/FiO₂ 48.9 mmHg), veno-venous extracorporeal membrane oxygenation (VV-ECMO) was initiated. Treatment: The patient was managed with a lung-protective ventilation strategy, prone positioning, and appropriate antimicrobial therapy. During ECMO support, severe mixed hyperbilirubinemia with a significant hemolytic component developed, characterized by a peak total bilirubin of 887 μmol/L. Management of hyperbilirubinemia included liver-protective agents, dual plasma molecular adsorption system (DPMAS), and therapeutic plasma exchange. Immunohematological tests confirmed immune-mediated hemolysis (positive direct and indirect antiglobulin tests). Outcome: Following ECMO decannulation, bilirubin levels normalized. The patient was successfully weaned from mechanical ventilation, transferred to a general ward, and eventually discharged, achieving full social reintegration. Conclusion: This case highlights the diagnostic challenge of differentiating between mechanical and immune-mediated hemolysis in ECMO patients and demonstrates the successful application of a combined therapeutic approach for severe ECMO-associated hyperbilirubinemia.
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