Abstract
BackgroundThe value of extracorporeal membrane oxygenation (ECMO) for patients suffering from novel coronavirus disease 2019 (COVID-19) as a rescue therapy for respiratory failure remains controversial and associated with high mortality rates of 50 to 82% in early reports from Wuhan, China. We hypothesized that patient outcomes would be improved at our tertiary cardiothoracic surgery referral center with a protocolized team-approach for ECMO treatment of patients with severe COVID-19 disease.Case presentationA 51-year-old healthy female developed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) bilateral pneumonia while vacationing in Colorado with her family. She was transferred to our facility for a higher level of care. Her respiratory status continued to deteriorate despite maximized critical care, including prone positioning ventilation and nitric oxide inhalation therapy. Veno-venous ECMO was initiated on hospital day 7 in conjunction with a 10-day course of compassionate use antiviral treatment with remdesivir. The patient’s condition improved significantly and she was decannulated from ECMO on hospital day 17 (ECMO day 11). She was successfully extubated and eventually discharged to rehabilitation on hospital day 28.ConclusionThis case report demonstrates a positive outcome in a young patient with COVID-19 treated by the judicious application of ECMO in conjunction with compassionate use antiviral treatment (remdesivir). Future prospective multi-center studies are needed to validate these findings in a larger cohort of patients.
Highlights
The value of extracorporeal membrane oxygenation (ECMO) for patients suffering from novel coronavirus disease 2019 (COVID-19) as a rescue therapy for respiratory failure remains controversial and associated with high mortality rates of 50 to 82% in early reports from Wuhan, China
This case report demonstrates a positive outcome in a young patient with COVID-19 treated by the judicious application of ECMO in conjunction with compassionate use antiviral treatment
If ECMO is considered as a treatment for COVID19, we suggest timely referral to a tertiary center with established expertise and standardized ECMO protocols
Summary
This case report demonstrates a positive outcome in a young, critically ill patient after judicious application of ECMO for respiratory failure due to SARS-CoV-2 pneumonia. FDA clearance The ECMO treatment described in this case report represents an FDAapproved indication. Authors’ contributions MSF provided the ECMO therapy and cardiothoracic consultation expertise for the multidisciplinary care of the patient described in this case report. PFS and MSF designed the case report and provided the first draft of the manuscript. JC, CK, and JF provided the critical care to the patient described in this case report. All authors provided critical feedback and input to the manuscript revisions and read and approved the final version of this case report. Consent for publication Written informed consent was obtained by the patient described in this case report for publication of the manuscript including all pertinent data, protected health information, and according images, radiographs, and photographs. Author details 1The Medical Center of Aurora, 1501 South Potomac St, Aurora, CO 80012, USA. Potomac Street, Suite 200, Aurora, CO 80012, USA. 3Department of Specialty Medicine, College of Osteopathic Medicine, Rocky Vista University, Parker, CO 80134, USA
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