Early extracorporeal life support as rescue therapy for severe acute respiratory distress syndrome after inhalation injury

Abstract

Acute respiratory distress syndrome (ARDS) remains a challenging disease leading to increased mortality in burn patients, and inhalation injury may contribute to the development of severe ARDS. Extracorporeal life support (ECLS) provides a method of gas exchange while allowing time for lung recovery in the setting of early, severe ARDS. Recent study suggests that a selected population of patients with severe ARDS may benefit from ECLS, especially if initiated early. We report a case of a 22-year-old man with Down syndrome who presented with isolated fire-induced smoke inhalation injury. He sustained no cutaneous burns. Forty-eight hours after presentation, the patient developed respiratory failure and hemodynamic instability refractory to conventional therapy, and ECLS was initiated on hospital day 2. By using "rest" ventilator settings and venovenous ECLS, the patient remained stable for a total of 6.5 days (160 hours) when he was successfully transitioned to a conventional ventilator and decannulated. The patient was discharged home on hospital day 50 on room air. ECLS aids innate lung recovery by allowing time for the diminution of high peak inspiratory pressures, prevention of barotrauma, and ultimately mitigating ventilator-induced lung injury. ECLS should be considered early as a viable supportive modality after inhalational injury in patients failing advanced ARDS management strategies.