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Hirudotherapy for Neonatal Limb Ischemia During ECMO Support: A Word of Caution
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  • Joseph Resch,
  • Sameh Said,
  • Marie Steiner,
  • Arif Somani
Joseph Resch
University of Minnesota Medical Center

Corresponding Author:[email protected]

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Sameh Said
University of Minnesota System
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Marie Steiner
University of Minnesota Medical Center
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Arif Somani
University of Minnesota Medical Center
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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.
26 Jan 2021Submitted to Journal of Cardiac Surgery
28 Jan 2021Submission Checks Completed
28 Jan 2021Assigned to Editor
07 Feb 2021Reviewer(s) Assigned
28 Feb 2021Review(s) Completed, Editorial Evaluation Pending
07 Mar 2021Editorial Decision: Revise Major
10 Mar 20211st Revision Received
10 Mar 2021Submission Checks Completed
10 Mar 2021Assigned to Editor
10 Mar 2021Review(s) Completed, Editorial Evaluation Pending
13 Mar 2021Editorial Decision: Accept
Jul 2021Published in Journal of Cardiac Surgery volume 36 issue 7 on pages 2549-2557. 10.1111/jocs.15539