Extracorporeal Membrane Oxygenation (ECMO) Transpires to be a Promising Surrogate Therapy for Severe Refractory near Fatal Asthma: A Case Report

The standard first-line therapy for severe asthma exacerbation is bronchodilators and corticosteroids. Any patients not responding to this standard therapy often needs invasive ventilation, which can promote numerous related complications and mortality. Recent studies conclude that ECMO can be adopted as an alternative approach as it significantly enhances the survival rate in severe respiratory failure compared to standard invasive ventilation. In contrast, ECMO effectiveness in near-fatal asthma is not well studied, possibly due to unpredictable asthma death before reaching the hospital and lack of current evidence-based studies that support the usage and benefits of ECMO. Herein, we present 39-year-old male as a case of near-fatal asthma with severe persistent hypercapnic respiratory failure refractory to conventional ventilation. Our early application of VV-ECMO for continuous 58 hours improved the patient hemodynamics and respiratory mechanics along with a rapid reduction of carbon dioxide tension. Thus it reduces the further complications and the length of the intensive care unit. Our case demonstrates the significance of the early hours of ECMO as promising surrogate therapy when conventional treatment fails. Long-term research urged to validate VV ECMO effectiveness in this group of patients.