Catheter directed thrombolysis for a pulmonary arterial thrombus on VA ECMO in a child - a case report.

Introduction: Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) as a bridge to cardiac transplantation is considered a high risk support strategy in the paediatric population.

Methods: We describe the case of a 12 year old boy who required V-A ECMO support for rapidly deteriorating cardiomyopathy and developed a massive pulmonary embolus (PE) peri-cannulation. Subsequent investigations were also positive for heparin induced thrombocytopenia.

Results: We elected to treat the PE with ultrasound accelerated catheter directed thrombolysis using the advantages of this minimally invasive targeted method to try and resolve the PE and avoid a cerebral haemorrhage, both of which would have taken the patient off the urgent transplant list.

Conclusion: The PE resolved in 24 h and he went on to receive a cardiac transplant and have a favourable outcome.