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CASE REPORT
Extracorporeal membrane oxygenation (ECMO) for near-fatal asthma refractory to conventional ventilation
  1. Usman Maqsood1,
  2. Nehal Patel2
  1. 1Respiratory Medicine, Royal Stoke University Hospital, Stoke on Trent, UK
  2. 2Critical Care Unit, Royal Stoke University Hospital, Stoke on Trent, UK
  1. Correspondence to Dr Usman Maqsood, drusmanmaqsood{at}yahoo.com

Summary

We describe a case of near-fatal asthma, treated successfully by initiation of extracorporeal membrane oxygenation (ECMO). A 29-year-old woman, known asthmatic on steroid inhalers, inhaled/nebulised bronchodilators, long-term oral prednisolone, theophylline and montelukast, presented with acute shortness of breath. She deteriorated following initial treatment with nebulised bronchodilators and magnesium sulfate requiring intubation and mechanical ventilation. Severe bronchospasm ensued following mechanical ventilation and peak airway pressures remained at 55 cm H2O with intrinsic positive end expiratory pressure(PEEP) of 14 cm H2O. Despite treatment with sedation, paralysis, intravenous salbutamol and inhaled sevoflurane, her condition deteriorated. She was commenced on mobile ECMO by the retrieval team. While on ECMO, her CO2 normalised within 48 hours. She was extubated within 72 hours of initiating ECMO and was discharged to the ward next day. We reiterate that ECMO should be considered sooner for status asthmatics not responding to maximal pharmacological therapy and ventilatory support to prevent ongoing lung injury and mortality.

  • asthma
  • mechanical ventilation
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Footnotes

  • Contributors UM wrote the initial draft and this was reviewed by NP. Patient was managed by both authors.

  • 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.

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