Journal of Artificial Organs

, Volume 21, Issue 4, pp 475–478 | Cite as

Rapid-onset plasma leakage of extracorporeal oxygenation membranes possibly due to hyperbilirubinemia

  • Yoshiko Kida
  • Shinichiro OhshimoEmail author
  • Michihito Kyo
  • Yuko Tanabe
  • Kei Suzuki
  • Koji Hosokawa
  • Nobuaki Shime
Case Report Artificial Lung / ECMO


Extracorporeal membrane oxygenation (ECMO) is an emerging tool for supporting cardiopulmonary function in patients with cardiorespiratory failure or arrest. The oxygenator of the ECMO circuit requires effective oxygenation and removal of carbon dioxide from the blood. Major problems that can occur with the oxygenator include plasma leakage, one of the late-onset serious complications necessitating device replacement. However, the rapid onset of plasma leakage is rare. We present a 1-year-old boy with acute respiratory failure due to Pneumocystis and Aspergillus pneumonia. He presented with tachypnea, tachycardia, and hypoxemia despite the ventilatory support, and was therefore placed on venoarterial ECMO with a drainage catheter from the right internal jugular vein (12 Fr) and a return catheter to the right internal carotid artery (10 Fr). Extracorporeal circulation was initiated at a blood flow of 1 L/min (145 mL/kg/min) and a sweep gas flow of 1 L/min with FiO2 of 0.7. Although he was successfully weaned from the venoarterial ECMO on day 15 with an improvement of cardiopulmonary function, he was later placed on venoarterial ECMO again because of the progression of pulmonary hypertension. Laboratory tests showed increased concentrations of hepatic enzymes and hyperbilirubinemia (total bilirubin 31.6 mg/dL). Six hours after starting ECMO circulation, plasma leakage from the oxygenator occurred. Although we replaced the oxygenator with a new one, the replacement showed plasma leakage after 6 h. Disassembly of the oxygenator revealed congestion from bilirubin in the membrane fibers. We described a case of repeated, rapid-onset plasma leakage after implementation of ECMO. Hyperbilirubinemia was likely associated with the plasma leakage of this patient.


Oxygenator Bilirubin Children 



Extracorporeal membrane oxygenation


Fraction of inspired oxygen


High flow nasal cannula


Intensive care unit


Partial pressure of carbon dioxide


Partial pressure of oxygen




Compliance with ethical standards

Availability of data and materials


Source of funding

This work was supported by the Japan Society for the Promotion of Science (JSPS) KAKENHI (Grant numbers JP16K09541, JP17K17052, and JP17K11573), the Strategic Information and Communications R&D Promotion Programme (SCOPE), and the Japan Agency for Medical Research and Development (AMED).


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Copyright information

© The Japanese Society for Artificial Organs 2018

Authors and Affiliations

  1. 1.Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health SciencesHiroshima UniversityHiroshimaJapan

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