Risk and relevance of open lung biopsy in pediatric ECMO patients: the Dutch experience

J Pediatr Surg. 2017 Mar;52(3):405-409. doi: 10.1016/j.jpedsurg.2016.11.031. Epub 2016 Nov 14.


Background: Open lung biopsy can help differentiate between reversible and irreversible lung disease and may guide therapy. To assess the risk-benefit ratio of this procedure in pediatric extracorporeal membrane oxygenation (ECMO) patients, we reviewed data of all patients who underwent an open lung biopsy during ECMO in one of the two pediatric ECMO centers in a nationwide study in the Netherlands.

Results: In nineteen neonatal and six pediatric patients (0-15.5years), twenty-five open lung biopsies were performed during the study period. In 13 patients (52%), a classifying diagnosis of underlying lung disease could be made. In another nine patients (36%), specific pathological abnormalities were described. In three patients (12%), only nonspecific abnormalities were described. The histological results led to withdrawal of ECMO treatment in 6 neonates with alveolar capillary dysplasia/misalignment of pulmonary veins (24%) and in another 6 patients, corticosteroids were started (24%). All patients survived the biopsy procedure. Hemorrhagic complications were rare.

Conclusion: An open lung biopsy during an ECMO run in neonates and children is a safe procedure with a minimum risk for blood loss and biopsy-related death. It can be very useful in diagnosing the underlying pathology and can guide cessation of ECMO treatment and thereby avoid continuation of futile treatment, especially in neonatal patients.

Level of evidence: III.

Type of study: Diagnostic study.

Keywords: Alveolar capillary dysplasia; Extracorporeal membrane oxygenation; Misalignment of pulmonary veins; Newborn; Open lung biopsy; Pulmonary hypertension.

MeSH terms

  • Adolescent
  • Biopsy / adverse effects*
  • Biopsy / methods
  • Biopsy / mortality
  • Child
  • Child, Preschool
  • Extracorporeal Membrane Oxygenation*
  • Female
  • Hemorrhage / etiology
  • Humans
  • Infant
  • Infant, Newborn
  • Infant, Newborn, Diseases / pathology
  • Lung / pathology*
  • Lung Diseases / etiology
  • Lung Diseases / pathology*
  • Male
  • Netherlands
  • Persistent Fetal Circulation Syndrome / pathology
  • Pulmonary Alveoli / abnormalities
  • Pulmonary Alveoli / pathology
  • Pulmonary Veins / abnormalities
  • Risk

Supplementary concepts

  • Alveolar capillary dysplasia