Ecmo Use in a Pediatric Patient: Management of Dengue-Related Septic Shock – A Case Report

Dengue is an arboviral disease common in tropical and subtropical regions, with manifestations ranging from mild to severe, such as septic shock and multiple organ failure. When conventional therapies fail, extracorporeal membrane oxygenation (ECMO) may be a therapeutic alternative. This technique has shown potential to improve survival in severe cases, especially in children, although it involves risks such as bleeding associated with dengue coagulopathy, requiring careful evaluation. A 3-year-old male patient was admitted with fever, vomiting, skin rash, and decreased level of consciousness. The dengue test (NS1 antigen) was positive. He progressed to septic shock, requiring transfer to the Pediatric Intensive Care Unit (PICU), and fluid resuscitation measures were initiated, as well as orotracheal intubation, antibiotic therapy, and vasoactive drugs. Blood cultures revealed oxacillin-sensitive Staphylococcus aureus. The patient progressed to severe acute respiratory distress syndrome, hemodynamic instability, and oliguria. Due to refractoriness to conventional treatment, ECMO was chosen. Cannulation was performed by the cardiac surgery team with installation of venoarterial ECMO. The procedure resulted in significant clinical improvement: hemodynamic stabilization, discontinuation of vasoactive drugs, and mechanical ventilation maintained at minimal settings to ensure coronary oxygenation. With clinical stabilization, after six days on ECMO, echocardiography showed improved cardiac output and support was withdrawn; the patient remained stable and was subsequently discharged from the PICU. This report reinforces the effectiveness of ECMO as a therapeutic strategy in situations of pediatric septic shock refractory to dengue. Although survival rates vary (around 70% in neonates and 40% in older children), ECMO is indicated when measures such as fluid replacement and inotropes do not result in improvement. Guidelines such as the Surviving Sepsis Campaign recommend its use, despite still limited evidence. Treatment success depends on team experience, the technology used, and timing of intervention. ECMO can be decisive in the management of severe dengue cases with cardiovascular dysfunction, highlighting the importance of specific protocols and its consideration in critical contexts.