Case Report: Respiratory Management With a 47-Day ECMO Support for a Critical Patient With COVID-19

Abstract

This paper reports a complete case of severe acute respiratory distress syndrome (ARDS) caused by coronavirus disease 2019 (COVID-19), who presented with rapid deterioration of oxygenation during hospitalization despite escalating high-flow nasal cannulation to invasive mechanical ventilation. After inefficacy with lung-protective ventilation, positive end-expiratory pressure (PEEP) titration, prone position, we administered extracorporeal membrane oxygenation (ECMO) as a salvage respiratory support with ultra-protective ventilation for 47 days and finally discharged the patient home with a good quality of life with a Barthel Index Score of 100 after 76 days of hospitalization. The purpose of this paper is to provide a clinical reference for the management of ECMO and respiratory strategy of critical patients with COVID-19-related ARDS.

Keywords: ARDS; COVID-19; ECMO; critical care; mechanical ventilation.

Figure 1

On admission, the patient presented with fever but without dyspnea. A chest CT showed bilateral scattered ground-glass opacities. On Day 4, although the patient still denied dyspnea, a chest CT showed progressive bilateral ground-glass opacities. On Day 8, the patient experienced a rapid decline of the P/F ratio, and a chest CT showed bilateral heterogeneous diffusive ground-glass opacities with consolidation in dorsal areas, much worse than previously, leading to intubation and then ECMO. After the patient had been weaned from ECMO, chest CT exams on Day 57 and Day 75 showed significant resolution of the consolidation and ground-glass opacities, which corresponded to a de-escalation of respiratory support. After being discharged from hospital, the patient had chest CT scanned 2 weeks after discharge, 1 month after discharge, and 1 year after discharge, respectively. These images revealed further resolution of former opacities.