Acute respiratory distress syndrome (ARDS) and acute kidney injury (AKI) represent critical complications that significantly burden the management of pediatric patients with extensive burns. We present a case of a four-year-old boy who sustained severe burns covering 56% of his total body (Burn Index 29). The patient developed ARDS on Day 3, which led to the initiation of venovenous extracorporeal membrane oxygenation (ECMO) on Day 5. Following the subsequent development of AKI and fluid overload, continuous renal replacement therapy (CRRT) was introduced on Day 6. To overcome the limitations of vascular access common in pediatric patients, a novel integrated approach was employed by connecting the CRRT circuit to a unique bypass between the ECMO limbs. This integrated system allowed for seamless treatment and effective fluid management, resulting in the resolution of pulmonary edema and a significant improvement in respiratory function. The patient was successfully weaned from ECMO on Day 10 and CRRT on Day 13, eventually being discharged on Day 90 following multiple skin grafting procedures. This case highlights that the integration of CRRT into an ECMO bypass line is a simple, safe, and effective modality for the life-saving treatment of pediatric severe burns complicated by multi-organ failure.
Matsuoka et al. (2026) studied this question.