The successful use of extracorporeal carbon dioxide removal as a rescue therapy in a patient with severe COVID-19 pneumonitis

Abstract

We present a patient with severe COVID-19 pneumonitis; poor respiratory compliance; dangerously high ventilator pressures; and hypercapnia refractory to conventional treatment including low tidal volume ventilation, neuromuscular blockade and prone position ventilation. Extracorporeal carbon dioxide removal was used as a rescue therapy to facilitate safer ventilator pressures and arterial partial pressures of carbon dioxide. After 6 days of treatment, the patient had improved to the extent that the extracorporeal support was able to be weaned and the patient was decannulated from the device. Following a prolonged respiratory wean, the patient was subsequently discharged from the intensive care unit and then from the hospital to home with no adverse events related to the therapy.

Keywords: hypercapnia: causes; low tidal volume ventilation: protective effect; lung protection ventilation: pressure goal; ventilator: low tidal volume.