Early venoarterial extracorporeal membrane oxygenation with airway clearance techniques in severe pertussis with pulmonary hypertension in a two-month-old infant: a case report.

backgroundSevere pertussis in young infants can lead to respiratory failure, pulmonary hypertension, and sepsis, and remains difficult to manage when conventional therapies fail. In such cases, extracorporeal membrane oxygenation (ECMO) combined with airway clearance techniques (ACT) may help stabilize cardiopulmonary function and relieve airway obstruction. CASE PRESENTATION: We report a case of a two-month-old female infant diagnosed with severe pertussis, presenting with acute respiratory failure, pulmonary hypertension, and refractory sepsis. Laboratory findings revealed significant leukocytosis (WBC: 67.56 × 10⁹/L) and elevated cardiac biomarkers. Despite leukoreduction and escalating respiratory support, the patient developed persistent hypoxemia and hemodynamic instability, indicating progressive cardiorespiratory failure. Venoarterial extracorporeal membrane oxygenation was initiated for cardiopulmonary support. Concurrent airway clearance techniques, including prone positioning, nebulised therapy, and bronchoscopic secretion removal, were implemented to manage severe airway obstruction. The patient showed progressive improvement in oxygenation and pulmonary hypertension during ECMO support, with successful decannulation after 163 h and discharge after 25 days of hospitalization, without major complications.

conclusionsThis case shows that early ECMO, when combined with structured airway clearance, may be beneficial in selected high-risk infants. Further studies are required to further validate the role of this combined approach.