The Prolonged Use of VV ECMO Support in COVID-19: A Case Report

Abstract

COVID-19 has resulted in unprecedented global health and economic challenges. The reported mortality in patients with COVID-19 requiring mechanical ventilation is high. VV ECMO may serve as a lifesaving rescue therapy for a minority of patients with COVID-19; however, its impact on overall survival of these patients is unknown. To date, few reports describe successful discharge from ECMO in COVID-19 after a prolonged ECMO run. The only Australian case of a COVID-19 patient, supported by prolonged VV ECMO in conjunction with prone ventilation, complicated by significant airway bleeding, and successfully decannulated after forty-two days, is described. VV ECMO is a resource-intense form of respiratory support. Providing complex therapies such as VV ECMO during a pandemic has its unique challenges. This case report provides a unique insight into the potential clinical sequelae of COVID-19, supported in an intensive care environment which was not resource-limited at the time, and adds to the evolving experience of prolonged VV ECMO support for ARDS with a goal to lung recovery.

Keywords: Coronavirus infection; acute respiratory distress syndrome (ARDS); extracorporeal life support; mechanical ventilation; prone positioning.

Fig.1

CT Chest Axial Imaging demonstrating progression and resolution of lung infiltration. Image A, B - Admission to hospital; C,D - Imaging performed on PEEP of 5 cmH2O and 40 cmH2O respectively;D - on day 13 of ECMO; E- Day 29 of ECMO; F - 13 days post decannulation.

Fig.2

Plain Chest radiographs demonstrating progression and resolution of lung infiltration. A - post intubation; B - initiation of ECMO; C - Day 13 of ECMO; D - Day 20 of ECMO after initiation of proning; E - Day 34 of ECMO; F - 13 days post ECMO decannulation.