Abstract
Despite advances in burn care, mortality in adult patients with extensive burn injuries remains a concern, particularly in those who develop concurrent acute respiratory distress syndrome (ARDS). In cases of ARDS refractory to conventional treatments, venovenous extracorporeal membrane oxygenation (ECMO) may represent a viable salvage therapy, even in the major burn population. We present the case of a 38-year-old man with full thickness burns to over 80% of his body, who developed severe ARDS 4 days postburn. After failing to respond to deep sedation, paralysis, and proning, ECMO therapy was initiated to maintain oxygenation and ventilation. Over the next 14 days, while the patient was treated with ECMO, he successfully underwent three major operations to debride and allograft approximately 65% of his body surface area, including one in the prone position. ECMO therapy was discontinued on postburn day 18, and the patient had his wounds reconstructed and survived his injuries. To the best of our knowledge, this is the first report of a burn patient with such severe burns requiring surgical intervention that has been treated with ECMO and survived, and the first case of a burn patient on ECMO having surgery in the prone position. They conclude this case serves as a “proof of concept” that ECMO is a potential treatment for appropriately selected major burn patients with ARDS who fail to respond to other therapies.
12 / Challenges in the assessment of post-extubation neurological status in an Intensive Care Unit (ICU): case report of a major burn patient