# Extracorporeal Membrane Oxygenation for Acute Respiratory Failure in a Dog

## TL;DR

A dog with severe respiratory failure due to barium aspiration was treated with ECMO, showing its potential in veterinary medicine despite eventual death from brain injury.

## Contribution

This case demonstrates the safe use of ECMO in veterinary medicine for acute respiratory failure.

## Key findings

- ECMO successfully stabilized the dog's respiration during tracheobronchial lavage.
- The dog regained consciousness briefly after ECMO but later developed neurological symptoms.
- ECMO is a viable rescue option for severe respiratory failure in dogs when conventional methods fail.

## Abstract

Extracorporeal membrane oxygenation (ECMO), a specialized medical technology that temporarily assumes the function of the heart and lungs, allows the body time to recover from severe respiratory failure. Although widely employed in human medicine, its application in veterinary medicine remains limited. Herein, we describe a 3-year-old dog that developed life-threatening respiratory distress after accidentally inhaling barium. Despite intensive ventilatory support, oxygenation failed to improve. ECMO was initiated as a last-resort measure to stabilize respiration, enabling tracheobronchial lavage despite temporary airway occlusion. Following barium removal and 3 h of support, ECMO was discontinued, and the dog regained consciousness. Unfortunately, neurological symptoms later developed, and the dog died 8 days after treatment owing to suspected brain injury caused by prolonged hypoxia before ECMO was initiated. This case highlights the safe application of ECMO in veterinary medicine as a rescue option in severe respiratory failure. It also emphasizes the ethical, logistical, and time-sensitive nature of decision-making in such critical situations. Even when temporary hypoxia occurs owing to diseases, irreversible organ injury may still prevent survival. Establishing clear guidelines and specialized training for veterinary teams is essential to ensure responsible and effective practices, leading to improved outcomes.

A 3-year-old West Highland White Terrier presented to our hospital with dyspnea following aspiration of barium contrast medium during diagnostic imaging for a suspected esophageal foreign body (day 0). Barium contrast radiography had revealed a foreign body in the lower esophagus. During anesthesia, the patient regurgitated and developed respiratory failure and cyanosis. Despite immediate intubation, suction, and ventilatory management, respiratory parameters remained poor. Respiratory support with extracorporeal membrane oxygenation (ECMO) enabled control of blood gas parameters, and tracheobronchial lavage with temporary complete airway occlusion was performed. ECMO was withdrawn once the respiratory status normalized (total support time: 3 h). Considering the possibility of hypoxia-induced brain damage, the patient was extubated on day 1. The dog was alert, changed positions, and drank water independently 5 h after extubation. However, neurological symptoms were observed 1 h later. Cranial magnetic resonance imaging was performed on day 6 owing to persistent neurological symptoms. Although no ECMO-related complications, such as cerebral infarction, hemorrhage, or herniation, were observed, the white matter exhibited hyposignal, indicating hypoxic encephalopathy. The patient died on day 8, without improvement in neurological symptoms. ECMO is an effective treatment option for dogs with respiratory failure, and its prompt introduction may improve survival.