Successful Extracorporeal Membrane Oxygenation (ECMO) Use without Systemic Anticoagulation for Acute Respiratory Distress Syndrome in a Patient with Aneurysmal Subarachnoid Hemorrhage

Extracorporeal membrane oxygenation (ECMO) is an important life-saving technology for patients with severe acute respiratory distress syndrome (ARDS). Unfortunately, ECMO has been traditionally contraindicated in patients with hemorrhagic neurologic diseases. The recent improvement in ECMO devices, increased utilization and experience with venovenous ECMO technologies among healthcare teams, and the use of ECMO without anticoagulation has expanded the potential populations that may benefit from ECMO. We present a case of successful utilization of venovenous ECMO for severe respiratory failure secondary to ARDS in a patient with aneurysmal subarachnoid hemorrhage and severe, episodic cerebral vasospasm. We also discuss important limitations and considerations for future successful use of ECMO in hemorrhagic stroke. This case report highlights the potential for this life-saving technology in patients with hemorrhagic stroke.

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A Failure to Oxygenate: A Case for Venovenous Extracorporeal Membrane Oxygenation

Cardiothoracic Critical Care ◽

10.1093/med/9780190082482.003.0023 ◽

2020 ◽

pp. 221-230

Author(s):

Cara Agerstrand ◽

Andrew Pellet

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Extracorporeal Membrane Oxygenation ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Life Support ◽

Metastatic Cancer ◽

Membrane Oxygenation ◽

Venovenous Extracorporeal Membrane Oxygenation ◽

Venovenous Ecmo

This chapter explains the utilization of venovenous extracorporeal membrane oxygenation (ECMO) for acute respiratory distress syndrome (ARDS). Venovenous ECMO provides respiratory support and is the most common ECMO configuration used during ARDS. Patient selection is of the utmost importance for successful use of ECMO. Patients being considered for venovenous ECMO for ARDS should meet criteria for severe ARDS. Best guidance can be taken from the Extracorporeal Life Support Organization recommendations and the multicenter Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome trial. The main contraindication to ECMO is any condition or organ dysfunction that would limit the overall benefit of ECMO, such as severe brain injury, metastatic cancer, or decompensated cirrhosis. Once the ECMO circuit is operational, ventilator settings must be optimized to protect the injured lungs by adhering to an ultra-lung-protective “lung rest” strategy.

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Early Initiation of Veno-venous Extracorporeal Membrane Oxygenation in the Emergency Room as A Salvage Treatment for Patients with Coronavirus Disease 2019 with Severe Acute Respiratory Distress Syndrome

10.22514/sv.2020.16.0102 ◽

2020 ◽

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Extracorporeal Membrane Oxygenation ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Emergency Room ◽

Distress Syndrome ◽

Early Introduction ◽

Membrane Oxygenation ◽

Life Saving ◽

Vv Ecmo

Background: Since veno-venous extracorporeal membrane oxygenation (VV-ECMO) is highly invasive and may be used over a long period of time, its introduction is usually carefully considered and planned. Here, we report the case of a life-saving procedure by introducing VV-ECMO in the emergency room. Case presentation: A 56 year-old man had fatigue for 3 days along with rapidly worsening dyspnea. On arrival at the emergency room, he presented with severe hypoxemia. Tracheal intubation and mechanical ventilation were immediately initiated; however, hypoxemia persisted. Therefore, VV-ECMO was introduced in the emergency room. The patient’s respiratory condition gradually improved, and VV-ECMO was terminated on hospital day 6. Conclusion: The early introduction of VV-ECMO in the emergency room was effective against acute respiratory distress syndrome caused by coronavirus disease 2019. Further studies should be performed to confirm the efficacy of early VV-ECMO introduction.

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