ECMO als Therapie des schweren Lungenversagens bei COVID-19

Zusammenfassung

Wir berichten über den Fall einer 60-jährigen Patientin mit fortgeschrittenem schwerem Lungenversagen bei COVID-19-assoziierter Pneumonie. Die Patientin erhielt zuerst 2 Tage eine (Highflow-)Sauerstoff-Therapie (HFNC) und CPAP, anschließend musste sie intubiert und invasiv beatmet werden. Nach dem Scheitern einer invasiven Beatmung mit schwerster Hypoxämie erfolgte der Anschluss an eine vv-ECMO. Diese wurde über 24 Tage durchgeführt. Die prognostischen Parameter zeigten ab Tag 14 eine günstige Tendenz. Nach Beendigung der ECMO und insgesamt 11 Tagen stundenweiser assistierter Beatmung über Tracheostoma und Sauerstoff (1 l/min) konnte die Patientin in die Rehabilitationsbehandlung verlegt werden. Die letzte Röntgenthoraxaufnahme zeigte eine nahezu vollständige Rückbildung der initialen ausgedehnten beidseitigen Verschattungen. Unser Fall zeigt, dass auch nach einer prolongierten ECMO-Therapie eine Ausheilung der schweren COVID-assoziierten Lungenschäden möglich ist.

Abstract

We report the case of a 60-year old female patient with advanced severe lung injury as a consequence of COVID-19-pneumonia. The patient was initially treated with highflow oxygen via nasal cannula (HFNC) and CPAP for two days but had to be intubated and mechanically ventilated. After failure of mechanical ventilation because of persistant severe hypoxemia treatment was switched to ECMO which was applicated for 24 days. Prognostic parameters indicated a favourable trend after day 14. After discontinuation of ECMO and 11 days of intermittent assisted ventilation via tracheostoma and low dose oxygen (1 l/min), the patient could be transferred to rehabilitation. The last chest radiograph prior to transferral revealed a nearly complete resolution of bilateral pulmonary infiltrates. Our case demonstrates that severe COVID-19-associated lung injury can be reversible even after prolonged ECMO.

Publication History

Received: 13 June 2020

Accepted: 15 June 2020

Article published online:
16 July 2020

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