Use of veno-venous extracorporeal membrane oxygenation in a female patient with severe acute respiratory distress syndrome and peri-intubation cardiac arrest. Clinical observation

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Acute respiratory distress syndrome (ARDS) is a life-threatening form of respiratory failure which can occur in people of any age. It comprises about 10 % of all admissions in intensive care units. The cornerstone of treatment of severe forms of this disorder is protective mechanical ventilation but in patients with initial hypoxia and/or hypotension tracheal intubation is associated with the risk of significant hemodynamic abnormalities. Mortality from severe forms of ARDS remains high. COVID-19 pandemic led to worldwide wider use of such techniques of respiratory support as high-flow nasal oxygen therapy and non-invasive ventilation, the necessity of which is proposed to be used as one of classifying signs of ARDS in addition to the Berlin criteria. If the respiratory therapy is ineffective, veno-venous extracorporeal membrane oxygenation is used for gaseous exchange and decreasing undesirable effects of high pressure in the respiratory pathways. The success of its application strongly depends on the optimal timing of its initialization. The performance of this technique is associated with a number of complications (hemorrhage, thrombosis, sepsis, etc.). Effective treatment of ARDS requires utilization of a large amount of resources and educated staff.