Case Report of Patients with Acute Respiratory Distress Syndrome Caused by COVID-19: Successfully Treated by Venovenous Extracorporeal Membrane Oxygenation and an Ultra-Protective Ventilation

Abstract

Coronavirus disease (COVID-19) started in Wuhan (China) at the end of 2019, and then increased rapidly. In patients with severe acute respiratory distress syndrome (ARDS) caused by COVID-19, venovenous extracorporeal membrane oxygenation (VV-ECMO) is considered a rescue therapy that provides adequate gas exchange. The way in which mechanical ventilation is applied during VV-ECMO is not clear, however it is associated with prognosis. Currently, the mortality rate of COVID-19 patients that receive VV-ECMO stands at approximately 50%. Here, we report three patients that successfully recovered from COVID-19-induced ARDS after VV-ECMO and implementation of an ultra-protective ventilation. This ventilation strategy involved maintaining a peak inspiratory pressure of ≤20 cmH₂O and a positive end-expiratory pressure (PEEP) of ≤ 10 cmH₂O, which are lower values than have been previously reported. Thus, we suggest that this ultra-protective ventilation be considered during VV-ECMO as it minimizes the ventilator-induced lung injury.

Keywords: COVID-19; acute respiratory distress syndrome; ultra-protective ventilation; venovenous extracorporeal membrane oxygenation.

Figure 1

Clinical course of the patient 1 maintaining the Venovenous-Extracorporeal membrane oxygenation (VV-ECMO).

Figure 2

Chest radiography of the patient 1. (a) on the day of ECMO application (b) on the day of ECMO discontinuation.

Figure 3

Clinical course of the patient 2 maintaining the VV-ECMO.

Figure 4

Chest radiography of the patient 2. (a) on the day of ECMO application (b) on the day of ECMO discontinuation.

Figure 5

Clinical course of the patient 3 maintaining the VV-ECMO.

Figure 6

Chest radiography of the patient 3. (a) on the day of ECMO application (b) on the day of ECMO discontinuation.