The Role of Extracorporeal Membrane Oxygenation Support in Malignant Infantile Pertussis

Background: Pertussis, or whooping cough, is an acute respiratory infection caused by Bordetella pertussis and Bordetella parapertussis. Malignant pertussis (acute respiratory distress syndrome (ARDS), hyperleukocytosis and pulmonary hypertension) is a severe form of pertussis, more common in young, non-vaccinated children, and almost always a fatal disease. Extracorporeal membrane oxygenation (ECMO) is used as an emergency treatment for children with life-threatening pertussis. However, the success rate is low, with only 30% survival rate.

Method: We report a clinical case of a newborn admitted at pediatric intensive care unit (PICU) due to malignant pertussis.

Results: A female newborn (28-days of age) with pertussis as a result of B. pertussis infection was admitted in PICU due to hyperleukocytosis (92030/uL) and worsening respiratory distress. Exchange transfusion was performed with mild improvement. Cardiac ultrasound revealed pulmonary hypertension. By day-2 there was clinical worsening with severe ARDS. After failure of conventional ventilation and high-frequency oscillatory ventilation, cannulation of internal jugular vein and common carotid artery was performed and venoarterial ECMO support was instituted. Due to anasarca, dialytic therapy was maintained between days 9 and 32. Serial transfontanelar ultrasounds were performed to access for brain complications. By day-20 ultrasound revealed brain hemorrhage and epileptic activity was noted, with abnormal eletroencephalogram. Antiepileptic therapy was started, with good response. After 41 days of ECMO support the patient was weaned off ECMO, and extubated to non-invasive ventilation 14 days later. She was discharged from PICU at day-63 in spontaneous ventilation. She was discharged home at day-105.

Conclusion: In this patient with malignant pertussis, ECMO was performed for cardiopulmonary support and rescued the infant. During ECMO support, mechanical ventilation with protective settings (high positive end-expiratory pressure and low tidal volumes) provided the opportunity for lung recovery. Despite complications (minor brain hemorrhage) the patient recovery with minor sequelae poses a good prognosis.