Mallick Taha, Barakat Mark, Baptiste Trevaughn R, Hasan Mahera, Engdahl Ryan
Surgery, Harlem Hospital Center, New York, USA.
Surgery, St. George's University School of Medicine, St. George's, GRD.
Cureus. 2020 Dec 6;12(12):e11938. doi: 10.7759/cureus.11938.
Lung damage in coronavirus disease 2019 (COVID-19) pneumonia may be so severe that management with lung-protective ventilation, neuromuscular blockade, and proning cannot sustain life. Extracorporeal membrane oxygenation (ECMO) may allow patients with acute respiratory distress syndrome (ARDS) to undergo a period of lung recovery before being transitioned back to mechanical ventilation. A successful outcome requires both timely initiation of ECMO before development of irreversible organ injury from severe ARDS and selection of patients with adequate physiologic reserve. We present a 40-year-old healthy male patient with severe COVID-19 pneumonia not responsive to more conservative options for ARDS management. Veno-venous extracorporeal membrane oxygenation (VV-ECMO) rescue therapy was instituted and after 34 days he was successfully decannulated and eventually discharged from the hospital in good condition. Despite needing ECMO for longer than what is reported in most case reports and series involving patients with COVID-19 pneumonia, our patient made a complete recovery. He was also followed up in an outpatient setting and seen to be doing well. With appropriate patient selection and timely initiation of ECMO, many patients stand to benefit from this treatment. Ensuring that therapy be delivered to these patients when the need arises requires meticulous planning and provision of the appropriate resources. In addition, inflammatory markers may serve as a further guide to decision-making in patients already on ECMO as has already been indicated in the literature.
2019冠状病毒病（COVID-19）肺炎导致的肺损伤可能非常严重，以至于采用肺保护性通气、神经肌肉阻滞和俯卧位通气等治疗方法无法维持生命。体外膜肺氧合（ECMO）可使急性呼吸窘迫综合征（ARDS）患者在转回机械通气之前有一段时间的肺恢复过程。成功的治疗结果既需要在严重ARDS导致不可逆器官损伤之前及时启动ECMO，也需要选择有足够生理储备的患者。我们报告一名40岁的健康男性患者，患有严重的COVID-19肺炎，对更保守的ARDS管理方案无反应。实施了静脉-静脉体外膜肺氧合（VV-ECMO）抢救治疗，34天后他成功拔管，最终康复出院。尽管与大多数涉及COVID-19肺炎患者的病例报告和系列研究相比，我们的患者需要ECMO的时间更长，但他完全康复了。他还在门诊接受了随访，情况良好。通过适当的患者选择和及时启动ECMO，许多患者有望从这种治疗中获益。要确保在有需要时为这些患者提供治疗，需要精心规划并提供适当的资源。此外，正如文献中已经指出的，炎症标志物可能作为已经接受ECMO治疗的患者决策的进一步指导。
