Purpose of the Study. This report presents the experience with one case of status asthmaticus who failed to respond to mechanical ventilation and was successfully managed with extracorporeal life support (ECLS) using venovenous bypass. The purpose is to inform the practitioner of an additional therapy, potentially of benefit, in management of asthma complicated by treatment-resistant respiratory failure.
Methods. Low volume venovenous bypass with extracorporeal life support resolved severe respiratory failure in a 23-year-old female asthmatic over a 22-hour period after failure of 5 hours of mechanical ventilation. Bypass was initiated remotely by an ECLS team using a portable ECLS circuit before the 180-mile transport to the "nearby" center. Details of the technique are presented.
Conclusion and Reviewer's Comments. This may be the first instance where asthma was the primary indication for ECLS; other asthmatics have been so treated, but for other complicating conditions like pneumonia and adult respiratory distress syndrome. This report provides a further alternative therapy, even in somewhat remote areas, for asthma-caused respiratory failure.
AbstractHere we report a case of a 40-year-old man who visited the emergency room with severe chest pain. He showed a Stanford type B aortic dissection on chest-computed tomography. Despite medical treatment and malperfusion of lower extremities, acute renal failure developed; hence thoracic endovascular aortic repair (TEVAR) was considered under general anaesthesia. After endotracheal intubation, ventilation with low tidal volume required high inspiratory airway pressure. An arterial blood gas analysis showed PaCO2 of 61.8mmHg and PaO2 of 26.4mmHg, indicating a status asthmaticus of hypoxaemia and hypercarbia, which did not respond to bronchodilator or mechanical ventilation. Impending cardiac arrest was treated using venovenous extracorporeal life support, which was administered by percutaneous femoral cannulation. Surgical procedure was completed without any complications. Extracorporeal life support was weaned at one day after the operation. The patient was discharged without any complications.
Outcomes Using Extracorporeal Life Support for Adult Respiratory Failure due to Status Asthmaticus