Douedi Steven, Alshami Abbas, Costanzo Eric
Internal Medicine, Hackensack Meridian Health, Jersey Shore University Medical Center, Neptune, USA.
Internal Medicine, Dorrington Medical Associates, Houston, USA.
Cureus. 2020 Apr 17;12(4):e7714. doi: 10.7759/cureus.7714.
Novel coronavirus 2019 (COVID-19) is a severe respiratory infection leading to acute respiratory distress syndrome (ARDS) accounting for thousands of cases and deaths across the world. Several alternatives in treatment options have been assessed and used in this patient population. However, when mechanical ventilation and prone positioning are unsuccessful, venovenous extracorporeal membrane oxygenation (VV-ECMO) may be used. We present a case of a 41-year-old female, with no significant medical history and no recent history of exposure to sick contacts, presented to the emergency department (ED) with fever, severe shortness of breath, and flu-like symptoms with a positive COVID-19 test. Ultimately, she worsened on mechanical ventilation and prone positioning and required VV-ECMO. The use of VV-ECMO in COVID-19 infected patients is still controversial. While some studies have shown a high mortality rate despite aggressive treatment, such as in our case, the lack of large sample size studies and treatment alternatives places healthcare providers against a wall without options in patients with severe refractory ARDS due to COVID-19.
2019新型冠状病毒（COVID-19）是一种严重的呼吸道感染疾病，可导致急性呼吸窘迫综合征（ARDS），在全球范围内造成了数千例病例和死亡。针对该患者群体，已经评估并采用了多种治疗方案。然而，当机械通气和俯卧位通气无效时，可使用静脉-静脉体外膜肺氧合（VV-ECMO）。我们报告一例41岁女性病例，该患者无重大病史，近期也无接触患病者的病史，因发热、严重呼吸急促和类似流感的症状就诊于急诊科（ED），COVID-19检测呈阳性。最终，她在机械通气和俯卧位通气治疗下病情恶化，需要使用VV-ECMO。在COVID-19感染患者中使用VV-ECMO仍存在争议。尽管一些研究表明，即便采取积极治疗，死亡率仍很高，比如我们的病例，但由于缺乏大样本量研究和治疗替代方案，对于因COVID-19导致严重难治性ARDS的患者，医疗服务提供者在治疗上往往无计可施。
