Pediatric Case Series of Endobronchial Valve Placement to Mitigate Persistent Air Leak on ECMO

Tuesday, March 24, 2026

12:30 PM - 1:30 PM Central Time

Location: Connections Central - RST 13

JR

James Nelson Reed, MD

Baylor College of Medicine Texas Children's Hospital

Disclosure(s): No relevant financial relationship(s) to disclose.
SD

Shailendra Das, DO

Assistant Professor
Baylor College of Medicine Texas Children's Hospital

Disclosure information not submitted.
AO

Andrea Ontaneda, MD

Assistant Professor
Baylor College of Medicine Texas Children's Hospital, Texas

Disclosure information not submitted.
AS

Arun Saini, MD, MS, FCCM

Baylor College of Medicine at Texas Childrens Hospital

Disclosure(s): No relevant financial relationship(s) to disclose.
MK

Melanie Kitagawa, MD, MHA

Assistant Professor
Baylor College of Medicine

Disclosure information not submitted.
JT

James Thomas, MD

Professor
Baylor College of Medicine Texas Children's Hospital

Disclosure information not submitted.
KD

Katherine Doane, MD

Assistant Professor
Baylor College of Medicine Texas Children's Hospital

Disclosure information not submitted.
NC

Nancy Chung, MD

Assistant Professor
UT Southwestern Medical Center

Disclosure information not submitted.
Marwa Mansour, MD

Texas

Disclosure(s): No relevant financial relationship(s) to disclose.

Introduction: Persistent air leaks (PAL) from bronchopleural fistulas are common in children with necrotizing pneumonia (NP) and often complicate management. Treatment typically involves chest tube drainage and minimizing positive pressure ventilation, though severe cases may require extracorporeal membrane oxygenation (ECMO) support. In refractory cases, PAL delays decannulation and increases ECMO-related risks. We describe three pediatric NP cases on ECMO in which endobronchial valve (EBV) placement resolved PAL.

Description: Case 1: A 15 year-old female with type 1 diabetes was cannulated onto veno-venous (VV) ECMO for influenza B and methicillin-resistant Staphylococcus aureus (MRSA) NP complicated by PAL. On ECMO day 81, a one-way 9mm EBV was placed in the left lower lobe (LLL). Due to persistent PAL on ECMO day 89, the valve was replaced with three EBVs (6mm, 7mm, and 9mm) distally in the LLL. PAL resolved within one week, after which ECMO was weaned with successful decannulation on ECMO day 138. Case 2: A 2 year-old male with NP and left-sided bronchopleural fistula was cannulated onto VV-ECMO. He experienced severe pulmonary hemorrhage and right heart failure, necessitating a two-week transition to veno-arterial (VA) ECMO. Due to PAL on ECMO day 48, a 7mm EBV was placed in the left lower bronchus. He was weaned off ECMO four days later, and the chest tube was removed one week after decannulation. Case 3: An 8 year-old female with influenza A, NP, and PAL was cannulated onto VV-ECMO. Despite weeks of VV-ECMO support complicated by pulmonary hemorrhage, the PAL failed to improve. Two 9mm EBVs were placed in the LLL on ECMO day 46, leading to resolution of the PAL and successful decannulation.

Discussion: PAL may prolong weaning from mechanical ventilation and ECMO and lead to increased complications in patients with NP. In all three cases, EBV placement successfully resolved PAL and promoted lung healing. EBVs were removed after 8 to 10 weeks without air leak recurrence. Successful deployment of EBVs with subsequent PAL resolution and decannulation in these patients, including one of the youngest ever reported on ECMO, may represent a novel therapeutic and risk mitigation strategy to avoid ECMO complications.