A successful case of extracorporeal membrane oxygenation for COVID-19: walking home without oxygen supplementation

Abstract

Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged from Wuhan, China in December 2019 and is the strain of coronavirus that causes coronavirus disease 2019 (COVID-19). Approximately one-third of the patients with COVID-19 require intensive care unit (ICU) admission, and almost 30% of the patients develop acute respiratory distress syndrome (ARDS). Extracorporeal membrane oxygenation (ECMO) is used as salvage therapy for severe ARDS. The role of ECMO in the treatment of COVID-19 remains unclear, although there is emerging evidence that this approach may be an effective salvage therapy for severe ARDS. Case Presentation: We present a case of a previously healthy 39-year-old Hispanic male who presented to the hospital with flu-like symptoms, including headache, fatigue, and myalgia for 8 days in late April 2020. He denied dyspnea on exertion. The patient's symptoms progressed, resulting in pneumonia and acute respiratory distress syndrome (ARDS). The patient was managed with prone positioning, convalescent plasma and veno-venous extracorporeal membrane oxygenation (VV-ECMO) for 35 days. The patient successfully recovered and was able to ambulate independently and was discharged home from an acute care hospital without oxygen supplementation on hospital day 63. Conclusion: We present one of the first few documented cases of ECMO for severe ARDS due to COVID-19. After a prolonged hospital course requiring VV-ECMO, the patient was discharged home from an acute care hospital without oxygen requirement and ambulated independently, likely as a result of daily aggressive mobility-focused rehabilitation.

Keywords: COVID-19; SARS-CoV-2; acute respiratory distress syndrome; ambulation; discharge home; extracorporeal membrane oxygenation; respiratory failure.

Figure 1.

Chest x-ray on hospital day 7 demonstrating diffuse multifocal lung infiltrates

Figure 2.

CT chest on hospital day 25 showing bilateral diffuse opacities

Figure 3.

CT chest on hospital day 58 (five days prior to discharge) demonstrating improvement of the bilateral opacities compared to Figure 2

Figure 4.

The patient ambulated independently and was discharged home without oxygen supplementation on hospital day 63. We have obtained consent from the patient to use this photograph

Figure 5.

Follow-up CT chest 20-days post-discharge showing complete resolution of the multifocal opacities when compared to the patient’s hospitalization