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CC BY-NC-ND 4.0 · Journal of Cardiac Critical Care TSS 2020; 4(02): 147-152
DOI: 10.1055/s-0040-1716637
Case Report

A 92 Days Run of Venovenous Extracorporeal Membrane Oxygenation

Manoj Kumar Sahu
1  Department of Cardiothoracic and Vascular Surgery, CN Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
,
Chalattil Bipin
1  Department of Cardiothoracic and Vascular Surgery, CN Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
,
Sourabh Pahuja
2  Department of Pulmonary Medicine, All India Institute of Medical Sciences, New Delhi, India
,
Sarvesh Pal Singh
1  Department of Cardiothoracic and Vascular Surgery, CN Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
,
Vijay Hadda
2  Department of Pulmonary Medicine, All India Institute of Medical Sciences, New Delhi, India
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Abstract

Background Venovenous extracorporeal membrane oxygenation (VV-ECMO) is an established life-saving procedure for severe acute respiratory failure due to various causes. In general, the duration of ECMO ranges from 1 to 2 weeks, with withdrawal recommended if no improvement is noted. We report a case of respiratory failure due to acute respiratory distress syndrome (ARDS) following influenza A infection, supported with a long ECMO run and the lessons learned from this experience.

Case Report A 40-year-old female weighing 120 kg with pneumonia following H1N1 influenza was transferred to our hospital on mechanical ventilation for worsening respiratory distress. On admission, she presented with bilateral diffuse infiltrates on chest X-ray and severe hypoxemia with a partial pressure of oxygen in arterial blood/fraction of inspired oxygen concentration ratio (PaO2/FiO2) of 85 at FiO2 of 0.8 on endotracheal intubation and mechanical ventilation. Acinetobacter Baumannii was isolated from respiratory secretions; antibiotics were revised as per sensitivity. Her respiratory status further deteriorated over next 96 hours in spite of maximally optimized mechanical ventilation. VV-ECMO was established on 4th day of mechanical ventilation in our hospital. Thereafter, she underwent a prolonged ECMO run with respiratory improvement starting to show some promise only by 86th day of ECMO. Weaning process was initiated gradually. However, on 88th day of ECMO the patient had an episode of seizure followed by low Glasgow Coma Scale (GCS) score (3T/15). The patient did not recover from the cerebral insult and based on clinical neurological examination including apnea test, brain death was determined within next 48 hours and the ECMO was called off.

Conclusions Prolonged ECMO therapy poses many challenges and might be considered if the primary cause of respiratory failure necessitating ECMO is expected to resolve or a feasibility of lung transplantation is contemplated. Good team dynamics and appropriate counselling to the family are of utmost importance managing the patients on prolonged ECMO.

Keywords

H1N1 influenza - acute respiratory distress syndrome - venovenous extracorporeal membrane oxygenation


Publication History

Publication Date:
08 October 2020 (online)

© 2020. Official Publication of The Simulation Society (TSS), accredited by International Society of Cardiovascular Ultrasound ISCU. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/.)

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