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

In a situation involving a 14-year-old with meconium aspiration who requires 100% oxygen, the most appropriate next step is to initiate ECMO (Extracorporeal Membrane Oxygenation). This advanced form of life support is especially indicated in severe cases of respiratory failure where conventional therapies have failed to adequately oxygenate the patient, particularly in cases where significant persistent hypoxemia is observed.

Meconium aspiration syndrome can lead to acute respiratory distress, and if the patient is not responding to standard treatments aimed at improving oxygenation, ECMO can provide temporary support by taking over the function of the heart and lungs. This allows for better oxygen delivery and carbon dioxide removal while the patient’s lungs can rest and heal.

Other options, such as maintaining the current therapy or increasing minute ventilation, may not provide sufficient improvement in oxygenation for a patient requiring 100% oxygen, demonstrating a critical level of respiratory compromise. The Rashkind procedure, which involves balloon atrial septostomy, typically addresses congenital heart defects through creating a shunt and is not applicable in cases of meconium aspiration. Therefore, initiating ECMO is the most appropriate and effective next step to manage the severe respiratory compromise in this scenario.