Veno‐venous extracorporeal membrane oxygenation for severe pneumonia: COVID‐19 case in Japan

Abstract Background: Extracorporeal membrane oxygenation (ECMO) is an extracorporeal life support system (ECLS) for patients with severe cardiopulmonary failure, there are two basic patterns of veno-arterial (V-A) and veno-venous (V-V). Case presentation: This paper mainly introduced a death case of modified ECMO Patterns which is veno-veno-venous ECMO in the treatment of silicosis with severe pneumonia and analyzed the cause of death after treatment with VV-V ECMO. Conclusions: Although VV-V ECMO is recommended for patients with extremely poor oxygenation conditions, it still be difficult to improve the prognosis of patients with severe lung structural damage, and still has a long way to go.

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Extracorporeal membrane oxygenation in COVID-19 patients and in-hospital mortality: results from the Brazilian Registry using a propensity score matched analysis

10.1101/2021.05.05.21256475 ◽

2021 ◽

Author(s):

Daniela Ponce ◽

Milena Soriano Marcolino ◽

Magda Carvalho Pires ◽

Rafael Lima Rodrigues de Carvalho ◽

Heloisa Reniers Vianna ◽

...

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Conventional Therapy ◽

Life Support ◽

Extracorporeal Life Support ◽

Severe Pneumonia ◽

Ecmo Support ◽

Lung Protective Ventilation ◽

Convenience Sample ◽

Membrane Oxygenation ◽

Number Of Patients

Around 5% of coronavirus disease 2019 (COVID-19) patients develop critical disease, with severe pneumonia and acute respiratory distress syndrome (ARDS). In these cases, extracorporeal membrane oxygenation (ECMO) may be considered when conventional therapy fails. This study aimed to assess the clinical characteristics and in-hospital outcomes of COVID-19 patients with ARDS refractory to standard lung-protective ventilation and pronation treated with ECMO support and to compare them to patients who did not receive ECMO. Patients were selected from the Brazilian COVID-19 Registry. At the moment of the analysis, 7,646 patients were introduced in the registry, eight of those received ECMO support (0.1%). The convenience sample of patients submitted to ECMO was compared to control patients selected by genetic matching for gender, age, comorbidities, pronation, ARDS and hospital, in a 5:1 ratio. From the 48 patients included in the study, eight received ECMO and 40 were matched controls. There were no significant differences in demographic, clinical and laboratory characteristics. Mortality was higher in the ECMO group (n = 7; 87.5%) when compared with controls (n = 17; 42.5%), (p=0.048). In conclusion, COVID 19 patients with ARDS refractory to conventional therapy who received ECMO support had worse outcomes to patients who did not receive ECMO. Our findings are not different from previous studies including a small number of patients, however there is a huge difference from Extracorporeal Life Support Organization results, which encourages us to keep looking for our best excellence.

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Early Detection of Legionella pneumophila and Aspergillus by mNGS in a Critically Ill Patient With Legionella Pneumonia After Extracorporeal Membrane Oxygenation Treatment: Case Report and Literature Review

Frontiers in Medicine ◽

10.3389/fmed.2021.686512 ◽

2021 ◽

Vol 8 ◽

Author(s):

Ruiming Yue ◽

Xiaoxiao Wu ◽

Tianlong Li ◽

Li Chang ◽

Xiaobo Huang ◽

...

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Antibiotic Treatment ◽

Legionella Pneumophila ◽

Pathogenic Bacteria ◽

Early Stage ◽

Clinical Manifestations ◽

Severe Pneumonia ◽

Detection Methods ◽

Critically Ill Patient ◽

Membrane Oxygenation

Legionella pneumophila can cause pneumonia, leading to severe acute respiratory distress syndrome (ARDS). Because of its harsh growth requirements, limited detection methods, and non-specific clinical manifestations, diagnosing Legionella pneumonia remains still challenging. Metagenomic next-generation sequencing (mNGS) technology has increased the rate of detection of Legionella. This study describes a patient who rapidly progressed to severe ARDS during the early stage of infection and was treated with extracorporeal membrane oxygenation (ECMO). Although his bronchoalveolar lavage fluid (BALF) was negative for infection and his serum was negative for anti-Legionella antibody, mNGS of his BALF and blood showed only the presence of Legionella pneumophila (blood mNGS reads 229, BALF reads 656). After antibiotic treatment and weaning from ECMO, however, he developed a secondary Aspergillus and Klebsiella pneumoniae infection as shown by mNGS. Mechanical ventilation and antibiotic treatment were effective. A search of PubMed showed few reports of secondary Aspergillus infections after Legionella infection. Severe pneumonia caused by any type of pathogenic bacteria may be followed by Aspergillus infection, sometimes during extremely early stages of infection. Patients with severe pneumonia caused by Legionella infection should undergo early screening for secondary infections using methods such as mNGS, enabling early and precise treatment, thereby simplifying the use of antibiotics and improving patient prognosis.

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