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.
Resumen
Disordered coagulation, clot formation and distal limb ischemia are complications of extracorporeal membrane oxygenation (ECMO) with significant morbidity and mortality.
Por qué esto importa para la hirudoterapia
Este reporte de caso describe el uso de terapia con sanguijuelas medicinales en un lactante de 2 semanas de edad y 2,7 kg que desarrolló isquemia bilateral de las extremidades distales mientras estaba en ECMO tras la reparación de coartación crítica y defecto del tabique ventricular. Después de tres aplicaciones de sanguijuelas, el paciente presentó hemorragia significativa del espacio interdigital adyacente al primer dedo del pie izquierdo, con una pérdida de sangre estimada de 450 ml y más de 300 ml de transfusiones de hemoderivados requeridas; posteriormente, el paciente progresó a disfunción orgánica terminal irreversible y se proporcionaron cuidados paliativos. El reporte es directamente relevante para la hirudoterapia, ya que documenta una complicación hemorrágica grave cuando se aplican sanguijuelas a un paciente con ECMO anticoagulado sistémicamente, lo que llevó a los autores a recomendar precaución en tales escenarios. Sin embargo, al tratarse de un reporte de caso único que involucra a un neonato críticamente enfermo con múltiples comorbilidades complejas, no puede establecer seguridad, eficacia o riesgo generalizables, y el resultado refleja la gravedad de la situación clínica subyacente más que la hirudoterapia por sí sola.
Citación
Hirudotherapy for neonatal limb ischemia during ECMO support: A word of caution.
Resch J et al. · Journal of cardiac surgery, 2021
Contexto clínico relacionado
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Añadido a la biblioteca ASH: March 18, 2026 · Última actualización del sitio: June 18, 2026