Hirudotherapy for neonatal limb ischemia during ECMO support: A word of caution
Research article published in Journal of cardiac surgery (2021)
Abstract
INTRODUCTION: Disordered coagulation, clot formation and distal limb ischemia are complications of extracorporeal membrane oxygenation (ECMO) with significant morbidity and mortality. Medicinal leech therapy (hirudotherapy) has been attempted in plastic and orthopedic surgeries to improve venous congestion and salvage ischemic flaps. To our knowledge this has not been reported in pediatric cardiac surgery or during ECMO support. We present a complex neonate whose ECMO course was complicated by distal limb ischemia for whom leech therapy was attempted. PATIENT AND INTERVENTION: A 2-week-old 2.7 kg infant required ECMO support secondary to perioperative multiorgan system dysfunction following repair of critical coarctation and ventricular septal defect. Despite systemic anticoagulation, his clinical course was complicated by arterial thrombus, vasopressor-induced vascular spasm and bilateral distal limb ischemia. Medicinal leech therapy was tried after initially failing conventional measures. RESULT: Following the third leech application, this patient developed significant hemorrhage from the web space adjacent to the left great toe. An estimated 450 ml of blood loss occurred and more than 300 ml of blood product transfusions were required. He ultimately progressed to irreversible systemic end organ dysfunction and comfort care was provided. CONCLUSION: The use of medicinal leech therapy in pediatric cardiac surgery may be considered to minimize the consequences of advanced limb ischemia and venous congestion. However, this should be used with caution while patients are systemically anticoagulated during ECMO support. A directed review is presented here to assist in determining optimal application and potential course of therapy.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
Disordered coagulation, clot formation and distal limb ischemia are complications of extracorporeal membrane oxygenation (ECMO) with significant morbidity and mortality.
Why This Matters for Hirudotherapy
This case report describes the use of medicinal leech therapy in a 2-week-old, 2.7 kg infant who developed bilateral distal limb ischemia while on ECMO following repair of critical coarctation and ventricular septal defect. After three leech applications, the patient experienced significant hemorrhage from the web space adjacent to the left great toe, with an estimated 450 ml blood loss and more than 300 ml of blood product transfusions required; the patient subsequently progressed to irreversible end-organ dysfunction and comfort care was provided. The report is directly relevant to hirudotherapy as it documents a severe bleeding complication when leeches are applied to a systemically anticoagulated ECMO patient, leading the authors to urge caution in such settings. However, as a single case report involving a critically ill neonate with multiple complex comorbidities, it cannot establish generalizable safety, efficacy, or risk, and the outcome reflects the severity of the underlying clinical situation rather than hirudotherapy alone.
Citation
Hirudotherapy for neonatal limb ischemia during ECMO support: A word of caution.
Resch J et al. · Journal of cardiac surgery, 2021
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