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Case Reports
. 2020 Oct 29;56(11):570.
doi: 10.3390/medicina56110570.

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

Mi Hwa Park  1 , Ah Jin Kim  2 , Man-Jong Lee  2 , Young Sam Kim  3 , Jung Soo Kim  1
Affiliations
Case Reports

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

Mi Hwa Park et al. Medicina (Kaunas). .

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.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Clinical course of the patient 1 maintaining the Venovenous-Extracorporeal membrane oxygenation (VV-ECMO).
Figure 2
Figure 2
Chest radiography of the patient 1. (a) on the day of ECMO application (b) on the day of ECMO discontinuation.
Figure 3
Figure 3
Clinical course of the patient 2 maintaining the VV-ECMO.
Figure 4
Figure 4
Chest radiography of the patient 2. (a) on the day of ECMO application (b) on the day of ECMO discontinuation.
Figure 5
Figure 5
Clinical course of the patient 3 maintaining the VV-ECMO.
Figure 6
Figure 6
Chest radiography of the patient 3. (a) on the day of ECMO application (b) on the day of ECMO discontinuation.
See this image and copyright information in PMC

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