PB0307 - Pediatric Pulmonary Embolism and Pulmonary Hypertension Associated With E-Cigarette Use

Sunday, June 25, 2023

18:30 – 19:30 ET

Room: Exhibition

Presenting Author(s)

Kristen Nelson McMillan, MD

Dir, Ped mechanical circulatory support; Ped cardiac critical care and heart failure
Chicagoland Children's Health Alliance
Valparaiso, Indiana, United States

Co-Author(s)

ES

Eric Stromberg

Pediatric cardiology fellow
Advocate Children's Heart Institute
Oak Lawn, Illinois, United States
SM

Sandra McIntyre

Pediatric DNP, Pediatric ICU, pulmonary hypertension
Advocate Children's Hospital
Oak Lawn, Illinois, United States
DW

Diane Ward

Pediatric cardiac nurse, pulmonary hypertension, anticoagulation
Advocate Children's Heart Institute
Oak Lawn, Illinois, United States
VD

Vincent Dorsey

Pediatric pharmacist, Pharm D
Advocate Children's Hospital
Oak Lawn, Illinois, United States
FY

Faeeq Yousaf

Pediatric pharmacist, Pharm D
Advocate Children's Hospital
Oak Lawn, Illinois, United States
JC

Jason Canner

Pediatric hematologist
Advocate Children's Hospital
Oak Lawn, Illinois, United States
EL

Eleanor Lee

Pediatric resident
Advocate Children's Hospital
Oak Lawn, Illinois, United States
EK

Erin Kim

Pediatric nephrologist
Advocate Children's Hospital
Oak Lawn, Illinois, United States
PC

Priya Chandra

Pediatric nephrologist
Advocate Children's Hospital
Oak Lawn, Illinois, United States
CU

Cynthia Urbas

Chief Pediatric Perfusionist
Advocate Children's Heart Institute
Oak Lawn, Illinois, United States
MN

Melissa Nater

Medical Director, Pediatric ECMO
Advocate Children's Heart Institute
Oak Lawn, Illinois, United States
LV

Luca Vricella

Chief, Pediatric Cardiothoracic Surgery; Co-Director of Pediatric Heart Institute
Chicagoland Children's Health Alliance
Oak Lawn, Illinois, United States
NH

Narutoshi Hibino

Pediatric cardiothoracic surgeon
Chicagoland Children's Health Alliance
Oak Lawn, Illinois, United States
CE

Chawki ElZein

Pediatric cardiothoracic surgeon
Chicagoland Children's Health Alliance
Oak Lawn, Illinois, United States
DP

Dhaval Patel

Pediatric interventional cardiologist
Advocate Children's Heart Institute
Oak Lawn, Illinois, United States

Background: Pediatric pulmonary embolism (PE) is rare but can be life-threatening. Improving awareness of those managing pediatric patients may lead to faster identification and management with improved survival. Risk-taking behavior that may promote hypercoagulability should be considered.

Aims: We aim to emphasize importance of multidisciplinary collaboration in cases of critical pediatric thrombosis.

Methods: We reviewed a pediatric PE case.

Results: A 17-year-old male with no medical history presented with acute chest pain and respiratory distress with elevated D dimer (16,445 ng/mL). Chest CT revealed extensive bilateral PE with right heart strain. Anticoagulation was initiated and he was transferred to our pediatric cardiac ICU. Echocardiography revealed suprasystemic pulmonary hypertension (PH) and biventricular dysfunction. During anesthetic induction for insertion of bilateral PA catheters for thrombolysis (EKOS), he experienced a cardiac arrest and was placed on VA-ECMO. EKOS catheters were subsequently placed and continued for 24 hours. He was on systemic bivalirudin per pediatric ECMO protocol. On ECMO day 2, cardiac function improved but PH remained. Follow-up CT revealed residual presumptive chronic PE, so he underwent surgical thrombectomy on ECMO day 3. He was decannulated from ECMO post-op with normal neurologic function. Hypercoagulable work-up obtained prior to ECMO revealed elevated factor 8 and von Willebrand factor. Following ECMO decannulation, the patient reported vaping with nicotine and THC-containing e-cigarettes multiple times per day for 3 years and difficulty breathing for 2 months prior to presentation.

Conclusion(s): Acute on chronic PE leading to pulmonary hypertension is relatively rare in children (CTEPH). Nicotine-based vaping has been reported to cause thrombotic coagulopathy and may promote a hypercoagulable and inflammatory state predisposing to PE. Although PE response teams are relatively common in adults, they are uncommon in pediatrics. A multidisciplinary pediatric thrombosis response team may enhance implementation of therapy and decrease delays in these critical cases.