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

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.

Extracorporeal membrane oxygenation, COVID-19, Severe acute respiratory syndrome coronavirus 2, Critical care

[1] Hemmila MR, Rowe SA, Boules TN, et al. Extracorporeal life support for severe acute respiratory distress syndrome in adults. Ann Surg. 2004;240:595-605.

[2] Ramanathan K, Antognini D, Combes A, et al. Planning and provision of ECMO services for severe ARDS during the COVID-19 pandemic and other outbreaks of emerging infectious diseases. Lancet Respir Med. 2020;8:518-526.

[3] Zeng Y, Cai Z, Xianyu Y, et al. Prognosis when using extracorporeal membrane oxygenation (ECMO) for critically ill COVID-19 patients in China: a retrospective case series. Crit Care. 2020;24:148.

[4] Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395:1054-1062.

[5] Wu C, Chen X, Cai Y, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med. 2020;180:934-943.

[6] The WHO Rapid Evidence Appraisal for COVID-19 Therapies (REACT) Working Group. Association between administration of systemic corti-costeroids and mortality among critically ill patients with COVID-19: a meta-analysis. JAMA. 2020.

[7] The RECOVERY Collaborative Group. Dexamethasone in hospitalized patients with Covid-19- preliminary report. N Engl J Med. 2020. doi:10.1056/NEJMoa2021436.