Department of Critical Care, Universitair Ziekenhuis Brussel, Laarbeeklaan, Belgium.
Department of Anaesthesia and Perioperative Care, Universitair Ziekenhuis Brussel (UZB), Laarbeeklaan, Belgium.
Perfusion. 2023 Nov;38(8):1746-1750. doi: 10.1177/02676591221127932. Epub 2022 Sep 21.
The use of extra-corporeal membrane oxygenation (ECMO) therapy to treat severe COVID-19 patients with acute respiratory failure is increasing worldwide. We reported herein the use of veno-venous ECMO in a patient with cold agglutinin haemolytic anaemia (CAHA) who suffered from severe COVID-19 infection.
A 64-year-old man presented to the emergency department (ED) with incremental complaints of dyspnoea and cough since one week. His history consisted of CAHA, which responded well to corticosteroid treatment. Because of severe hypoxemia, urgent intubation and mechanical ventilation were necessary. Despite deep sedation, muscle paralysis and prone ventilation, P/F ratio remained low. Though his history of CAHA, he still was considered for VV-ECMO. As lab results pointed to recurrence of CAHA, corticosteroids and rituximab were started. The VV-ECMO run was short and rather uncomplicated. Although, despite treatment, CAHA persisted and caused important complications of intestinal ischemia, which needed multiple surgical interventions. Finally, the patient suffered from progressive liver failure, thought to be secondary to ischemic cholangitis. One month after admission, therapy was stopped and patient passed away.
Our case report shows that CAHA is no contraindication for VV-ECMO, even when both titre and thermal amplitude are high. Although, the aetiology of CAHA and its response to therapy will determine the final outcome of those patients.
在全球范围内，使用体外膜肺氧合（ECMO）治疗急性呼吸衰竭的严重 COVID-19 患者的方法正在增加。我们在此报告了一例冷抗体自身免疫性溶血性贫血（CAHA）合并严重 COVID-19 感染患者使用静脉-静脉 ECMO 的情况。
一名 64 岁男性因呼吸困难和咳嗽逐渐加重一周而到急诊科就诊。他有 CAHA 病史，曾用皮质类固醇治疗有效。由于严重低氧血症，需要紧急插管和机械通气。尽管进行了深度镇静、肌肉松弛和俯卧位通气，但 P/F 比值仍较低。尽管有 CAHA 病史，但仍考虑使用 VV-ECMO。由于实验室结果提示 CAHA 复发，开始使用皮质类固醇和利妥昔单抗。VV-ECMO 运行时间短且相对简单。然而，尽管进行了治疗，CAHA 仍然存在并导致了重要的并发症，如肠缺血，需要多次手术干预。最终，患者出现进行性肝功能衰竭，被认为是缺血性胆管炎所致。入院一个月后，停止治疗，患者死亡。
我们的病例报告表明，CAHA 不是 VV-ECMO 的禁忌证，即使滴度和热振幅都很高。然而，CAHA 的病因及其对治疗的反应将决定这些患者的最终结局。
