The ongoing war in Ukraine has placed extreme strain on the healthcare system, particularly for pediatric patients requiring complex medical interventions. This case report presents the extraordinary challenges of prolonged extracorporeal membrane oxygenation (ECMO) support in a 12-year-old girl suffering from severe congenital heart disease, critical aortic stenosis, myocarditis, and multi-organ complications.
Background and Challenges of ECMO in Wartime
In Kyiv, where hospitals struggle with disrupted supply chains and limited resources, ECMO support remains a highly challenging intervention. This patient’s condition deteriorated rapidly, necessitating urgent intervention, but the lack of available transplant options forced medical teams to explore alternative solutions.
Her case required an unprecedented 259 days of ECMO support due to the absence of heart-lung transplant capabilities in Ukraine. During this period, the hospital faced significant challenges in acquiring necessary ECMO components, particularly durable oxygenators. As a result, the medical team was forced to use polypropylene fiber oxygenators, including Quadrox-i and Terumo Fx15, which are generally not recommended for long-term use due to their rapid degradation, thrombosis, and declining oxygen exchange efficiency.
Clinical Course and ECMO Management
The patient was initially stabilized with VV-ECMO but later transitioned to VA-ECMO due to worsening cardiac function. The ECMO system required frequent adaptations, including the replacement of oxygenators a total of ten times over the course of treatment. The breakdown of oxygenator performance showed significant variation:
- EUROSETS oxygenators demonstrated better durability, with one lasting 88 days.
- Paragon PMP oxygenator functioned for 78 days.
- Maquet PLS oxygenator lasted 14 days.
- Terumo Fx15 and Quadrox-i oxygenators failed within 1–5 days due to thrombosis and mechanical failure.
Despite meticulous anticoagulation management with heparin, recurrent thrombosis necessitated multiple ECMO circuit replacements. The patient also suffered from pulmonary complications, including hemorrhages, requiring blood transfusions and bronchial occlusion procedures.
The Impact of Wartime Conditions on Medical Treatment
The inability to access long-term, high-performance oxygenators and the need for frequent replacements increased both procedural risks and patient instability. The supply chain disruptions in Ukraine meant that even basic biomedical devices were difficult to obtain. This case highlights how conflict-affected healthcare systems must rely on suboptimal equipment, significantly impacting patient survival.
Additionally, the lack of transplant infrastructure was a critical factor in the patient’s outcome. Without access to heart-lung transplantation, her cardiac function never recovered despite daily rehabilitation and mobilization efforts.
Outcomes and Conclusion
Ultimately, ECMO support was discontinued after 259 days due to irreversible heart failure and multi-organ dysfunction. Despite the extraordinary efforts of the medical team, the patient passed away, underscoring the extreme limitations of prolonged ECMO use in a warzone.
This case exemplifies the resilience and adaptability required in conflict-affected healthcare environments. It also highlights the urgent need for international support in providing durable medical equipment, ensuring supply chain stability, and facilitating patient transfers to specialized medical centers.
Key Takeaways:
- Prolonged ECMO is feasible in conflict zones but highly challenging due to resource limitations.
- Durable oxygenators are critical for long-term ECMO support, yet were unavailable in this case.
- The absence of transplant infrastructure greatly limited patient survival.
- International collaboration is necessary to improve access to advanced medical interventions in war-torn regions,
Study Ranking = 3 (Moderate quality case report). The study provides detailed clinical data but is a single-case report without a control group. The findings are context-specific to wartime conditions and may not generalize to all ECMO cases. The study highlights critical real-world challenges but lacks large-scale statistical analysis.
Additional Editorial from the IPA Management:
”Donald Trump’s stance on Ukraine is deeply concerning and undermines both American values and global stability. His repeated praise for Vladimir Putin, reluctance to fully support Ukraine, and suggestions that he could “end the war in 24 hours” reflect a dangerous misunderstanding of the stakes involved. Ukraine is fighting not just for its sovereignty but for the principles of democracy and self-determination—values that the U.S. has long championed.
Rather than firmly opposing Russian aggression, Trump has entertained ideas that would likely lead to Ukraine’s forced capitulation, rewarding Putin’s blatant violations of international law. His approach signals weakness, not strength, and would embolden authoritarian regimes worldwide. If the U.S. withdraws support, it risks not only Ukraine’s future but also the security of NATO allies, potentially dragging America into larger conflicts down the line.
Supporting Ukraine is not simply an act of charity; it is a strategic investment in global security. A Ukrainian victory would send a strong message that invasions and war crimes will not be tolerated, while a Russian triumph would encourage further destabilization, particularly in Eastern Europe. Trump’s isolationist rhetoric ignores the reality that American leadership is crucial in maintaining stability and deterring future conflicts.
Rather than embracing an approach that strengthens democracy and upholds international norms, Trump’s position leans toward appeasement, which history has shown to be a dangerous path. The U.S. has the opportunity to stand firmly on the right side of history by continuing to support Ukraine. Abandoning this fight would not only be a moral failure but a strategic misstep with long-term consequences for global peace and security.”
