Case Report: Respiratory Management With a 47-Day ECMO Support for a Critical Patient With COVID-19

Wen Xu; Ruoming Tan; Jie Huang; Shuai Qin; Jing Wu; Yuzhen Qiu; Simin Xie; Yan Xu; Ying Du; Feng Li; Bailing Li; Yingchuan Li; Yuan Gao; Xin Li; Hongping Qu

doi:10.3389/fmed.2021.714387

Case Report: Respiratory Management With a 47-Day ECMO Support for a Critical Patient With COVID-19

Front Med (Lausanne). 2021 Dec 24:8:714387. doi: 10.3389/fmed.2021.714387. eCollection 2021.

Authors

Wen Xu¹, Ruoming Tan¹, Jie Huang¹, Shuai Qin¹, Jing Wu¹, Yuzhen Qiu¹, Simin Xie², Yan Xu³, Ying Du¹, Feng Li⁴, Bailing Li⁵, Yingchuan Li⁶, Yuan Gao⁷, Xin Li⁸, Hongping Qu¹

Affiliations

¹ Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
² Department of Respiratory Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
³ Department of Critical Care Medicine, Ruijin Hospital North, Shanghai Jiaotong University School of Medicine, Shanghai, China.
⁴ Intensive Care Unit, Shanghai Public Health Clinical Center, Shanghai, China.
⁵ Department of Cardiovascular Surgical Intensive Care Unit (ICU), Changhai Hospital, Shanghai, China.
⁶ Department of Critical Care Medicine, The Sixth People's Hospital, Shanghai Jiaotong University, Shanghai, China.
⁷ Department of Critical Care Medicine, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
⁸ Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.

Abstract

This paper reports a complete case of severe acute respiratory distress syndrome (ARDS) caused by coronavirus disease 2019 (COVID-19), who presented with rapid deterioration of oxygenation during hospitalization despite escalating high-flow nasal cannulation to invasive mechanical ventilation. After inefficacy with lung-protective ventilation, positive end-expiratory pressure (PEEP) titration, prone position, we administered extracorporeal membrane oxygenation (ECMO) as a salvage respiratory support with ultra-protective ventilation for 47 days and finally discharged the patient home with a good quality of life with a Barthel Index Score of 100 after 76 days of hospitalization. The purpose of this paper is to provide a clinical reference for the management of ECMO and respiratory strategy of critical patients with COVID-19-related ARDS.

Keywords: ARDS; COVID-19; ECMO; critical care; mechanical ventilation.

Publication types

Case Reports