#35938 Venovenous ECMO in near fatal ashtma: case report

Abstract

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Background and Aims

VV-ECMO is used for the temporary support of patients with respiratory failure most commonly due to Acute Respiratory Distress Syndrome (ARDS). Use in near fatal asthma (NFA) is found only in case reports. We intend to present a case of NFA that received support with VV-ECMO.

Methods

A 21-yo man, asthmatic, with medication nonadherance developed a status asthmaticus that failed to respond to non-invasive therapy requiring intubation and mechanical ventilation (MV). After 24 hours on MV he developed pneumomediastinum, continued with severe respiratory acidosis and developed increased intracranial pressure (ICP). He was commenced on VV-ECMO therapy, his CO2 was normalized within 48 hours. MV was continued, still with high peak pressures, he received Sevofluorane for 24 hours. After 48 hours with ECMO he developed midriasis due to ICP and intracranial hemorrhage was seen in the CT scan. He was treated with hiperosmolar therapy. Diagnosis of acute hemorrhagic leukoencephalitis (AHL) is done after finding Herpes Virus type 1 in CSF. 6 days after cannulation the bronchospasm solved and 48 hours after ECMO was discontinued. A tracheostomy was done the day after the discontinuation of ECMO and the next day the patient woke up and followed commands. He was discharged home 8 days after ECMO weaning.

Results

Support for NFA is not commonly performed with ECMO. The finding of AHL is not a common complication seen in these cases nor a favorable outcomes.

Conclusions

VV-ECMO should be considered to be part of support in NFA but thus should be addressed in future trials.