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  • Early initiation of venovenous extracorporeal membrane oxygenation in a mechanically ventilated patient with severe acute respiratory distress syndrome

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CASE REPORT
Early initiation of venovenous extracorporeal membrane oxygenation in a mechanically ventilated patient with severe acute respiratory distress syndrome
  1. Nisha Krishnakant Raiker1,
  2. Hector Cajigas2
  1. 1Internal Medicine, McGaw Medical Center of Northwestern University, Chicago, Illinois, USA
  2. 2Pulmonary and Critical Care, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Dr Nisha Krishnakant Raiker, nisha.raiker{at}northwestern.edu

Summary

A 49-year-old man presented to the emergency department with acute-onset dyspnoea and hypoxaemia 1 day following nasal surgery for obstructive sleep apnoea. A chest X-ray showed diffuse bilateral pulmonary infiltrates. Supplemental 100% fractional inspired oxygen (FiO2) via non-rebreather mask was delivered with resulting arterial oxygen tension:FiO2 ratio of 67. Transthoracic echocardiogram demonstrated normal heart function. A clinical diagnosis of severe acute respiratory distress syndrome (ARDS) was promptly made. Based on patient preference to avoid intubation and following a multidisciplinary approach, we decided to initiate venovenous extracorporeal membrane oxygenation (VV-ECMO) as an alternative strategy to mechanical ventilation. Though he ultimately required brief mechanical ventilation during ECMO cannulation, the patient spent a total of 5 days on VV-ECMO and a total of 8 days in the intensive care unit. Six days after discharge, his pulmonary function test demonstrated no significant abnormalities. We present a rare case of early initiation of VV-ECMO in a patient with severe ARDS that served as a bridge to recovery.

  • mechanical ventilation
  • respiratory medicine
  • intensive care
  • adult intensive care

https://doi.org/10.1136/bcr-2018-226223

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    Footnotes

    • Contributors NKR and HC had significant contributions to the conception of the idea for this work, the investigation of relevant literature, the writing and revising this manuscript, and gave final approval for the publication of this work. NKR and HC ensure the integrity of this work by accepting full responsibility for all included content, and any inquiries pertaining to this work will be addressed.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.