In the case of a 14-year-old with meconium aspiration needing 100% oxygen, what is the recommended next step?

In the scenario involving a 14-year-old patient with meconium aspiration who is requiring 100% oxygen, the appropriate next step is to consider the initiation of ECMO (Extracorporeal Membrane Oxygenation). Meconium aspiration syndrome can lead to severe respiratory distress, and if the patient is not responding adequately to conventional ventilation strategies—such as requiring high levels of oxygen—the situation becomes critical.

ECMO serves as a life-saving intervention in cases of severe respiratory failure, providing both oxygenation and removal of carbon dioxide while allowing the lungs to rest and heal. When a patient needs 100% oxygen, it often indicates severe hypoxemia that cannot be corrected with standard therapy. ECMO can deliver higher levels of oxygen and sufficient circulation to the body, thereby improving survival rates in critically ill patients with refractory respiratory failure.

In this context, while enhancing minute ventilation or maintaining current therapy might provide some level of support, they are unlikely to resolve the dire situation adequately. Additionally, the Rashkind procedure, which is an intervention primarily for certain congenital heart defects, would not be relevant here as it does not address the acute respiratory failure resulting from meconium aspiration. Thus, in such severe cases, ECMO represents the most effective next