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A Case of Extracorporeal Membrane Oxygenation as a Salvage Therapy for COVID-19-Associated Severe Acute Respiratory Distress Syndrome: Mounting Evidence.
J Investig Med High Impact Case Rep. 2020 Jan-Dec; 8:2324709620957778.JI

Abstract

Coronavirus disease 2019 (COVID-19) caused by a novel human coronavirus has led to a tsunami of viral illness across the globe, originating from Wuhan, China. Although the value and effectiveness of extracorporeal membrane oxygenation (ECMO) in severe respiratory illness from COVID-19 remains unclear at this time, there is emerging evidence suggesting that it could be utilized as an ultimate treatment in appropriately selected patients not responding to conventional care. We present a case of a 32-year-old COVID-19 positive male with a history of diabetes mellitus who was intubated for severe acute respiratory distress syndrome (ARDS). The patient's hypoxemia failed to improve despite positive pressure ventilation, prone positioning, and use of neuromuscular blockade for ventilator asynchrony. He was evaluated by a multidisciplinary team for considering ECMO for refractory ARDS. He was initiated on venovenous ECMO via dual-site cannulation performed at the bedside. Although his ECMO course was complicated by bleeding, he showed a remarkable improvement in his lung function. ECMO was successfully decannulated after 17 days of initiation. The patient was discharged home after 47 days of hospitalization without any supplemental oxygen and was able to undergo active physical rehabilitation. A multidisciplinary approach is imperative in the initiation and management of ECMO in COVID-19 patients with severe ARDS. While ECMO is labor-intensive, using it in the right phenotype and in specialized centers may lead to positive results. Patients who are young, with fewer comorbidities and single organ dysfunction portray a better prognosis for patients in which ECMO is utilized.

Authors+Show Affiliations

University of Nebraska Medical Center, Omaha, NE, USA.University of Nebraska Medical Center, Omaha, NE, USA.University of Nebraska Medical Center, Omaha, NE, USA.University of Nebraska Medical Center, Omaha, NE, USA.University of Nebraska Medical Center, Omaha, NE, USA.University of Nebraska Medical Center, Omaha, NE, USA.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

32911986

Citation

Rajdev, Kartikeya, et al. "A Case of Extracorporeal Membrane Oxygenation as a Salvage Therapy for COVID-19-Associated Severe Acute Respiratory Distress Syndrome: Mounting Evidence." Journal of Investigative Medicine High Impact Case Reports, vol. 8, 2020, p. 2324709620957778.
Rajdev K, Farr LA, Saeed MA, et al. A Case of Extracorporeal Membrane Oxygenation as a Salvage Therapy for COVID-19-Associated Severe Acute Respiratory Distress Syndrome: Mounting Evidence. J Investig Med High Impact Case Rep. 2020;8:2324709620957778.
Rajdev, K., Farr, L. A., Saeed, M. A., Hooten, R., Baus, J., & Boer, B. (2020). A Case of Extracorporeal Membrane Oxygenation as a Salvage Therapy for COVID-19-Associated Severe Acute Respiratory Distress Syndrome: Mounting Evidence. Journal of Investigative Medicine High Impact Case Reports, 8, 2324709620957778. https://doi.org/10.1177/2324709620957778
Rajdev K, et al. A Case of Extracorporeal Membrane Oxygenation as a Salvage Therapy for COVID-19-Associated Severe Acute Respiratory Distress Syndrome: Mounting Evidence. J Investig Med High Impact Case Rep. 2020 Jan-Dec;8:2324709620957778. PubMed PMID: 32911986.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A Case of Extracorporeal Membrane Oxygenation as a Salvage Therapy for COVID-19-Associated Severe Acute Respiratory Distress Syndrome: Mounting Evidence. AU - Rajdev,Kartikeya, AU - Farr,Lyndie A, AU - Saeed,Muhammad Ahsan, AU - Hooten,Rorak, AU - Baus,Joseph, AU - Boer,Brian, PY - 2020/9/11/entrez PY - 2020/9/12/pubmed PY - 2020/9/26/medline KW - ARDS KW - COVID-19 KW - ECMO KW - acute respiratory distress syndrome KW - extracorporeal membrane oxygenation SP - 2324709620957778 EP - 2324709620957778 JF - Journal of investigative medicine high impact case reports JO - J Investig Med High Impact Case Rep VL - 8 N2 - Coronavirus disease 2019 (COVID-19) caused by a novel human coronavirus has led to a tsunami of viral illness across the globe, originating from Wuhan, China. Although the value and effectiveness of extracorporeal membrane oxygenation (ECMO) in severe respiratory illness from COVID-19 remains unclear at this time, there is emerging evidence suggesting that it could be utilized as an ultimate treatment in appropriately selected patients not responding to conventional care. We present a case of a 32-year-old COVID-19 positive male with a history of diabetes mellitus who was intubated for severe acute respiratory distress syndrome (ARDS). The patient's hypoxemia failed to improve despite positive pressure ventilation, prone positioning, and use of neuromuscular blockade for ventilator asynchrony. He was evaluated by a multidisciplinary team for considering ECMO for refractory ARDS. He was initiated on venovenous ECMO via dual-site cannulation performed at the bedside. Although his ECMO course was complicated by bleeding, he showed a remarkable improvement in his lung function. ECMO was successfully decannulated after 17 days of initiation. The patient was discharged home after 47 days of hospitalization without any supplemental oxygen and was able to undergo active physical rehabilitation. A multidisciplinary approach is imperative in the initiation and management of ECMO in COVID-19 patients with severe ARDS. While ECMO is labor-intensive, using it in the right phenotype and in specialized centers may lead to positive results. Patients who are young, with fewer comorbidities and single organ dysfunction portray a better prognosis for patients in which ECMO is utilized. SN - 2324-7096 UR - https://www.unboundmedicine.com/medline/citation/32911986/A_Case_of_Extracorporeal_Membrane_Oxygenation_as_a_Salvage_Therapy_for_COVID_19_Associated_Severe_Acute_Respiratory_Distress_Syndrome:_Mounting_Evidence_ DB - PRIME DP - Unbound Medicine ER -