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Case Reports
. 2021 Mar 16;9(8):1953-1967.
doi: 10.12998/wjcc.v9.i8.1953.

Extracorporeal membrane oxygenation for coronavirus disease 2019-associated acute respiratory distress syndrome: Report of two cases and review of the literature

Jun-Lin Wen  1 , Qi-Zhe Sun  2 , Zhou Cheng  1 , Xiao-Zu Liao  1 , Li-Qiang Wang  1 , Yong Yuan  3 , Jian-Wei Li  4 , Liu-Sheng Hou  3 , Wen-Jun Gao  5 , Wei-Jia Wang  6 , Wei-Yan Soh  7 , Bin-Fei Li  8 , Da-Qing Ma  2
Affiliations
Case Reports

Extracorporeal membrane oxygenation for coronavirus disease 2019-associated acute respiratory distress syndrome: Report of two cases and review of the literature

Jun-Lin Wen et al. World J Clin Cases. .

Abstract

Background: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2, is a worldwide pandemic. Some COVID-19 patients develop severe acute respiratory distress syndrome and progress to respiratory failure. In such cases, extracorporeal membrane oxygenation (ECMO) treatment is a necessary life-saving procedure.

Case summary: Two special COVID-19 cases-one full-term pregnant woman and one elderly (72-year-old) man-were treated by veno-venous (VV)-ECMO in the Second People's Hospital of Zhongshan, Zhongshan City, Guangdong Province, China. Both patients had developed refractory hypoxemia shortly after hospital admission, despite conventional support, and were therefore managed by VV-ECMO. Although both experienced multiple ECMO-related complications on top of the COVID-19 disease, their conditions improved gradually. Both patients were weaned successfully from the ECMO therapy. At the time of writing of this report, the woman has recovered completely and been discharged from hospital to home; the man remains on mechanical ventilation, due to respiratory muscle weakness and suspected lung fibrosis. As ECMO itself is associated with various complications, it is very important to understand and treat these complications to achieve optimal outcome.

Conclusion: VV-ECMO can provide sufficient gas exchange for COVID-19 patients with acute respiratory distress syndrome. However, it is crucial to understand and treat ECMO-related complications.

Keywords: Acute respiratory distress syndrome; COVID-19; Case report; Complications; Coronavirus; Extracorporeal membrane oxygenation; SARS-CoV-2.

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Conflict of interest statement

Conflict-of-interest statement: The authors declare no conflict of interests.

Figures

Figure 1
Figure 1
Case 1 timeline. ECMO: Extracorporeal membrane oxygenation; MODS: Multiple organ dysfunction syndrome; MV: Mechanical ventilation; VV: Veno-venous.
Figure 2
Figure 2
Case 2 timeline. ECMO: Extracorporeal membrane oxygenation; MODS: Multiple organ dysfunction syndrome; MV: Mechanical ventilation; PCI: Percutaneous coronary intervention; VV: Veno-venous.
Figure 3
Figure 3
Chest X-rays before and after extracorporeal membrane oxygenation in case 1. A: Day of extracorporeal membrane oxygenation (ECMO); B: Day of weaning-off ECMO.
Figure 4
Figure 4
Chest X-rays before and after extracorporeal membrane oxygenation in case 2. A: Day of extracorporeal membrane oxygenation (ECMO); B: Day of weaning-off ECMO.
Figure 5
Figure 5
Chest computed tomography images of case 2.
Figure 6
Figure 6
Treatments and medications after admission in case 1. ECMO: Extracorporeal membrane oxygenation; CRRT: Continuous renal replacement therapy.
Figure 7
Figure 7
Laboratory test results during extracorporeal membrane oxygenation in case 1. ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; BNP: B-type natriuretic peptide; BUN: Blood urea nitrogen; CK: Creatine kinase; DBIL: Direct bilirubin; ECMO: Extracorporeal membrane oxygenation; FiO2: Fraction of inspired oxygen; PaO2: Partial pressure of oxygen; TBIL: Total bilirubin; VV: Veno-venous.
Figure 8
Figure 8
Treatments and medications after admission in case 2. CRRT: Continuous renal replacement therapy; ECMO: Extracorporeal membrane oxygenation.
Figure 9
Figure 9
Laboratory test results during extracorporeal membrane oxygenation in case 2. BNP: B-type natriuretic peptide; BUN: Blood urea nitrogen; DBIL: Direct bilirubin; ECMO: Extracorporeal membrane oxygenation; FiO2: Fraction of inspired oxygen; LDH: Lactate dehydrogenase; PaO2: Partial pressure of oxygen; TBIL: Total bilirubin; VV: Veno-venous.
Figure 10
Figure 10
Chest computed tomography images of case 1.
Figure 11
Figure 11
Severe acute respiratory syndrome coronavirus-2 nucleic acid test results of case 1. ECMO: Extracorporeal membrane oxygenation; PCR: Polymerase chain reaction; VV: Veno-venous.
Figure 12
Figure 12
Severe acute respiratory syndrome coronavirus-2 nucleic acid test results of case 2. ECMO: Extracorporeal membrane oxygenation; PCR: Polymerase chain reaction; VV: Veno-venous; ICU: Intensive care unit.
Figure 13
Figure 13
Comparations of partial pressure of oxygen/fraction of inspired oxygen ratios of case 1 and case 2. ECMO: Extracorporeal membrane oxygenation; FiO2: Fraction of inspired oxygen; PaO2: Partial pressure of oxygen; VV: Veno-venous.
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