Guo Fengwei, Deng Chao, Shi Tao, Yan Yang
Department of Cardiovascular surgery, First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an, 710061, P.R. China.
Eur Heart J Case Rep. 2020 Dec 12;5(1):ytaa462. doi: 10.1093/ehjcr/ytaa462. eCollection 2021 Jan.
Respiratory failure is a life-threatening complication of coronavirus disease 2019 (COVID-19)-related acute respiratory distress syndrome. Extracorporeal membrane oxygenation (ECMO) in COVID-19 might offer promise based on our clinical experience. However, few critically ill cases with COVID-19 have been weaned off ECMO.
A 66-year-old Chinese woman presented with fever (38.9°C), cough, dyspnoea, and headache. She had lymphopenia (0.72 × 10/L) and computed tomography findings of ground-glass opacities. Subsequently, she was confirmed to have respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. She was intubated after transfer to the intensive care unit due to respiratory failure and heart failure. However, her condition continued to deteriorate rapidly. Veno-veno ECMO was undertaken for respiratory and cardiac support due to refractory hypoxemic respiratory failure and bradyarrhythmia (45 b.p.m.). During hospitalization, she was also administered anti-viral treatment, convalescent plasma therapy, and continuous renal replacement therapy. She was maintained on ECMO before she had fully recovered from the condition that necessitated ECMO use and had a negative test for the nucleic acids of SARS-CoV-2 twice. Forty-nine days later, this patient was weaned from ECMO. At the most recent follow-up visit (3 months after weaning from ECMO), she received respiratory and cardiac rehabilitation and did not complain of any discomfort.
As far as we know, the longest duration of ECMO treatment in this critical case with COVID-19 is supportive of ECMO as the most aggressive form of life support and the last line of defence during the COVID-19 epidemic.
呼吸衰竭是2019冠状病毒病（COVID-19）相关急性呼吸窘迫综合征的一种危及生命的并发症。基于我们的临床经验，COVID-19患者使用体外膜肺氧合（ECMO）可能带来希望。然而，很少有COVID-19危重症患者成功撤机。
一名66岁中国女性，出现发热（38.9℃）、咳嗽、呼吸困难和头痛症状。她存在淋巴细胞减少（0.72×10/L），计算机断层扫描显示有磨玻璃影。随后，确诊感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）。因呼吸衰竭和心力衰竭转入重症监护病房后行气管插管。然而，她的病情仍迅速恶化。由于难治性低氧性呼吸衰竭和缓慢性心律失常（45次/分钟），进行了静脉-静脉ECMO以提供呼吸和心脏支持。住院期间，还给予了抗病毒治疗、康复期血浆治疗和持续肾脏替代治疗。在她从需要使用ECMO的病情中完全康复且两次严重急性呼吸综合征冠状病毒2核酸检测均为阴性之前，一直维持ECMO支持。49天后，该患者成功撤机。在最近一次随访（撤机后3个月）时，她接受了呼吸和心脏康复治疗，且未诉任何不适。
据我们所知，该COVID-19危重症病例中最长的ECMO治疗时间，支持ECMO作为最积极的生命支持形式以及COVID-19疫情期间的最后一道防线。
