Successful Use of Veno-Venous Extracorporeal Membrane Oxygenation in a Patient With Severe COVID-19 Pneumonia

Mallick, Taha; Barakat, Mark; Baptiste, Trevaughn R; Hasan, Mahera; Engdahl, Ryan

Lung damage in coronavirus disease 2019 (COVID-19) pneumonia may be so severe that management with lung-protective ventilation, neuromuscular blockade, and proning cannot sustain life. Extracorporeal membrane oxygenation (ECMO) may allow patients with acute respiratory distress syndrome (ARDS) to undergo a period of lung recovery before being transitioned back to mechanical ventilation. A successful outcome requires both timely initiation of ECMO before development of irreversible organ injury from severe ARDS and selection of patients with adequate physiologic reserve. We present a 40-year-old healthy male patient with severe COVID-19 pneumonia not responsive to more conservative options for ARDS management. Veno-venous extracorporeal membrane oxygenation (VV-ECMO) rescue therapy was instituted and after 34 days he was successfully decannulated and eventually discharged from the hospital in good condition. Despite needing ECMO for longer than what is reported in most case reports and series involving patients with COVID-19 pneumonia, our patient made a complete recovery. He was also followed up in an outpatient setting and seen to be doing well. With appropriate patient selection and timely initiation of ECMO, many patients stand to benefit from this treatment. Ensuring that therapy be delivered to these patients when the need arises requires meticulous planning and provision of the appropriate resources. In addition, inflammatory markers may serve as a further guide to decision-making in patients already on ECMO as has already been indicated in the literature.