Utilization of extracorporeal membrane oxygenation for refractory status asthmaticus during pregnancy: A case report

Abstract

Refractory status asthmaticus represents the most severe clinical presentations of asthma, and it is typically associated with the presence of hypoxemia, hypercapnia, lactic acidosis, dynamic hyperventilation and altered state of consciousness. Several case re ports have demonstrated extracorporeal membrane oxygenation (ECMO) as an alternative treatment method for patients with sta tus asthmaticus that failed to respond to maximal conventional therapy. We experienced a case of pregnant woman with severe asthma attack not relieved by conventional treatment, in whom early administration of ECMO resulted in a good outcome. A 23-year-old woman at, 11 weeks of pregnancy, was admitted with acute asthma attack. Despite maximal rescue therapies with me chanical ventilation, her condition gradually deteriorated. Venovenous ECMO was initiated 4 hours from intubation and gas ex change with lung mechanics was rapidly recovered within hours. She was extubated 45 hours after initiation of ECMO and had suc cessful weaning from ECMO 2 days after extubation. The patient had no complication and gave birth to a healthy baby at 37 weeks of gestation. This is the first case report in Korea on the successful use of ECMO in a pregnant woman with severe respiratory insuffi ciency due to status asthmaticus, who failed to respond to mechanical ventilation and maximum pharmacological treatment. Early ECMO application is a useful treatment option for patients with refractory status asthmaticus refractory to conventional therapy. (Al lergy Asthma Respir Dis 2020;8:92-95)