{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T18:16:37Z","timestamp":1770747397706,"version":"3.49.0"},"reference-count":12,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T00:00:00Z","timestamp":1770681600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Guangxi Key Laboratory of Diagnosis and Treatment of Acute Respiratory Distress Syndrome","award":["ZZH2020013"],"award-info":[{"award-number":["ZZH2020013"]}]},{"name":"Guangxi Zhuang Autonomous Region Clinical Medical Research Center for Severe Treatment Major Infectious Diseases","award":["AD22035101"],"award-info":[{"award-number":["AD22035101"]}]},{"name":"Application for Self-funded Scientific Research Project of Health Committee of Guangxi Zhuang Autonomous Region","award":["Z20201099"],"award-info":[{"award-number":["Z20201099"]}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>History<\/jats:title>\n                    <jats:p>A 51-year-old male presented with a 9-day history of fever and cough, progressing to severe respiratory failure refractory to conventional management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Diagnostic methods<\/jats:title>\n                    <jats:p>High-throughput sequencing confirmed influenza A virus. Chest CT revealed bilateral pneumonia and pulmonary edema. Due to a persistently low oxygenation index (PaO\u2082\/FiO\u2082 48.9\u202fmmHg), veno-venous extracorporeal membrane oxygenation (VV-ECMO) was initiated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Treatment<\/jats:title>\n                    <jats:p>The patient was managed with a lung-protective ventilation strategy, prone positioning, and appropriate antimicrobial therapy. During ECMO support, severe mixed hyperbilirubinemia with a significant hemolytic component developed, characterized by a peak total bilirubin of 887\u202f\u03bcmol\/L. Management of hyperbilirubinemia included liver-protective agents, dual plasma molecular adsorption system (DPMAS), and therapeutic plasma exchange. Immunohematological tests confirmed immune-mediated hemolysis (positive direct and indirect antiglobulin tests).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome<\/jats:title>\n                    <jats:p>Following ECMO decannulation, bilirubin levels normalized. The patient was successfully weaned from mechanical ventilation, transferred to a general ward, and eventually discharged, achieving full social reintegration.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case highlights the diagnostic challenge of differentiating between mechanical and immune-mediated hemolysis in ECMO patients and demonstrates the successful application of a combined therapeutic approach for severe ECMO-associated hyperbilirubinemia.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1709850","type":"journal-article","created":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T06:47:05Z","timestamp":1770706025000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Severe hyperbilirubinemia secondary to ECMO in a ARDS patient: a case report"],"prefix":"10.3389","volume":"13","author":[{"given":"Yamin","family":"Gao","sequence":"first","affiliation":[{"name":"Department of Critical Care Medicine, The People\u2019s Hospital of Guangxi Zhuang Autonomous Region","place":["Nanning, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, The People\u2019s Hospital of Guangxi Zhuang Autonomous Region","place":["Nanning, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuchen","family":"Duan","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, The People\u2019s Hospital of Guangxi Zhuang Autonomous Region","place":["Nanning, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhai","family":"Huang","sequence":"additional","affiliation":[{"name":"Guangxi Academy of Medical Sciences","place":["Nanning, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaogang","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, The People\u2019s Hospital of Guangxi Zhuang Autonomous Region","place":["Nanning, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,10]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"992","DOI":"10.1016\/S0140-6736(24)01588-5","article-title":"Optimal patient and mechanical circulatory support device selection in acute myocardial infarction cardiogenic shock","volume":"404","author":"Jacob","year":"2024","journal-title":"Lancet"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"460","DOI":"10.1111\/aor.14895","article-title":"Clinical characteristics and long-term outcomes of venoarterial extracorporeal membrane oxygenation in children with congenital heart 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Cholestasis of sepsis: a case report and review of the literature on differential causes of jaundice in ICU patient","volume":"42","author":"Pawe\u0142","year":"2019","journal-title":"Int J Artif Organs"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"589","DOI":"10.1007\/s12519-022-00563-z","article-title":"Ursodeoxycholic acid as adjuvant treatment to phototherapy for neonatal hyperbilirubinemia: a systematic review and meta-analysis","volume":"18","author":"Ilari","year":"2022","journal-title":"World J Pediatr"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1709850\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T06:47:06Z","timestamp":1770706026000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1709850\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,10]]},"references-count":12,"alternative-id":["10.3389\/fmed.2026.1709850"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1709850","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,10]]},"article-number":"1709850"}}