Veno-venous extracorporeal membrane oxygenation for severe pneumonia: COVID-19 case in Japan

Taniguchi, Hayato; Ogawa, Fumihiro; Honzawa, Hiroshi; Yamaguchi, Keishi; Niida, Shoko; Shinohara, Mafumi; Takahashi, Kohei; Iwashita, Masayuki; Abe, Takeru; Kubo, Sousuke; Kudo, Makoto; Takeuchi, Ichiro

After admission, oxygen therapy was maintained and 1 g cefepime and 1800 mg clindamycin phosphate were given every day. On day 3, pneumonia worsened ( Fig. 1, day 3) , which led to acute respiratory distress syndrome (ARDS). She was transferred to the general intensive care unit and then intubated (Fig. 2) . Lopinavir/ritonavir, which was approved by the ethics committee as a treatment for COVID-19, was given for 2 weeks. Three days later, as serum creatine level increased, urine output was almost zero and metabolic acidosis caused excessive spontaneous breathing (Table 1) . Although cardiac function was normal, norepinephrine was needed to maintain blood pressure. We determined that the reason for hypoxia was not cardiogenic congestion by acute kidney injury in chronic kidney disease, but severe ARDS and septic shock that had developed from SARS-CoV-2.