ArticleEuropean journal of pediatrics2026
Extracorporeal membrane oxygenation for life-threatening measles in children: a case series.
Article in European journal of pediatrics, 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
Measles is resurgent worldwide, and although vaccine-preventable, severe disease can progress to cardiorespiratory failure refractory to conventional support. This study aimed to determine whether extracorporeal membrane oxygenation (ECMO) is feasible in children with measles. A retrospective case series at a tertiary pediatric intensive care unit (PICU) with a regional ECMO program, of all children younger than 18 years with laboratory-confirmed measles who received ECMO during the August 2025-May 2026 outbreak. Of 49 children with measles admitted to the PICU, 10 received ECMO. Five were male; median age was 11 months (IQR, 10-24), and none had completed age-appropriate vaccination. Indications were septic shock or cardiorespiratory failure (n = 5), acute respiratory distress syndrome with septic shock (n = 2), hypoxemic respiratory failure (n = 2), and suspected myocarditis (n = 1). Seven received venoarterial, 1 veno-venoarterial, and 2 venovenous ECMO. Bacteremia preceded ECMO in 5 children and positive sputum culture in 8. Candida tropicalis candidemia developed in 3 of the first 5 patients, with none among the subsequent 5 after antifungal prophylaxis at cannulation. Left ventricular dysfunction was present in 7 of 9 assessed, 4 required decompression, and neuroimaging was abnormal in 4 of 8 imaged. Six children (60%) survived to discharge.
conclusionsECMO was feasible and potentially lifesaving in measles-associated cardiorespiratory failure, with survival comparable to other high-acuity pediatric indications, but the course was complicated by bacterial and fungal coinfection, cardiac dysfunction, and neurologic injury. These resource-intensive presentations occurred exclusively in unvaccinated children and were preventable, underscoring measles vaccination coverage as a public health priority. WHAT IS KNOWN: • Measles is resurgent worldwide and can cause severe respiratory, cardiac, and immune complications in children. • Measles-induced immune suppression predisposes to secondary bacterial and fungal infection. WHAT IS NEW: • First reported series of ECMO for measles: feasible, with 60% survival, but marked by coinfection, cardiac dysfunction, and neurologic injury. • Antifungal prophylaxis at ECMO cannulation was associated with elimination of candidemia in this cohort.
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