Early initiation of awake venovenous extracorporeal membrane oxygenation (ECMO) in critical COVID-19 pneumonia: A case reports

Bleomycin treats malignancies, such as germ cell tumours and Hodgkin lymphoma. While efficacious, it can cause severe drug-induced lung injury. We present a 42-year-old patient with stage IIB seminoma treated with radical orchiectomy followed by adjuvant chemotherapy with bleomycin, etoposide and cisplatin. His postbleomycin course was complicated by the rapid onset of hypoxic respiratory failure, progressing to acute respiratory distress syndrome and requiring venovenous extracorporeal membrane oxygenation (VV-ECMO) support. Although the patient was treated with high dose systemic steroids and ultra-protective ventilator strategies to minimise ventilator-induced lung injury while on VV-ECMO, his lung injury failed to improve. Care was withdrawn 29 days later. Lung autopsy revealed diffuse organising pneumonia. We found six case reports (including this one) of bleomycin-induced lung injury requiring VV-ECMO with a cumulative survival of 33% (2/6). While VV-ECMO may be used to bridge patients to recovery or lung transplant, the mortality is high.

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Fatal air embolism as complication of percutaneous dilatational tracheostomy on venovenous extracorporeal membrane oxygenation, two case reports

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-016-0489-9 ◽

2016 ◽

Vol 11 (1) ◽

Cited By ~ 6

Author(s):

Achim Lother ◽

Tobias Wengenmayer ◽

Christoph Benk ◽

Christoph Bode ◽

Dawid L. Staudacher

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Case Reports ◽

Percutaneous Dilatational Tracheostomy ◽

Air Embolism ◽

Dilatational Tracheostomy ◽

Membrane Oxygenation ◽

Venovenous Extracorporeal Membrane Oxygenation

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Early initiation of venovenous extracorporeal membrane oxygenation in a mechanically ventilated patient with severe acute respiratory distress syndrome

BMJ Case Reports ◽

10.1136/bcr-2018-226223 ◽

2018 ◽

pp. bcr-2018-226223 ◽

Cited By ~ 2

Author(s):

Nisha Krishnakant Raiker ◽

Hector Cajigas

Keyword(s):

Mechanical Ventilation ◽

Acute Respiratory Distress Syndrome ◽

Extracorporeal Membrane Oxygenation ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Early Initiation ◽

Membrane Oxygenation ◽

Venovenous Extracorporeal Membrane Oxygenation ◽

Vv Ecmo

A 49-year-old man presented to the emergency department with acute-onset dyspnoea and hypoxaemia 1 day following nasal surgery for obstructive sleep apnoea. A chest X-ray showed diffuse bilateral pulmonary infiltrates. Supplemental 100% fractional inspired oxygen (FiO2) via non-rebreather mask was delivered with resulting arterial oxygen tension:FiO2 ratio of 67. Transthoracic echocardiogram demonstrated normal heart function. A clinical diagnosis of severe acute respiratory distress syndrome (ARDS) was promptly made. Based on patient preference to avoid intubation and following a multidisciplinary approach, we decided to initiate venovenous extracorporeal membrane oxygenation (VV-ECMO) as an alternative strategy to mechanical ventilation. Though he ultimately required brief mechanical ventilation during ECMO cannulation, the patient spent a total of 5 days on VV-ECMO and a total of 8 days in the intensive care unit. Six days after discharge, his pulmonary function test demonstrated no significant abnormalities. We present a rare case of early initiation of VV-ECMO in a patient with severe ARDS that served as a bridge to recovery.

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