key: cord-0770428-huznxa8x
authors: Xiaomin, Hu; Lei, Xu; Peng, Wu; Tong, Li
title: ECMO 11-day-offline treatment of COVID-19 induced acute respiratory distress syndrome: A case report and a single-center experience
date: 2022-01-01
journal: Asian J Surg
DOI: 10.1016/j.asjsur.2021.12.063
sha: 2641b0e0b285762ef7abf443ba50304aeea18c17
doc_id: 770428
cord_uid: huznxa8x

nan

Approximately 15e30% of COVID-19 patients would develop to acute respiratory distress syndrome (ARDS) within a short period of time, 1 even leading to death. ECMO treatment has shown some advantages in influenza A, MERS and other outbreaks. 2, 3 Most ECMO teams in China indicated that COVID-19 ECMO auxiliary management was more difficult and required longer auxiliary time. Here, we report a case of severe COVID-19 induced ARDS with ECMO assisted offline for 11 days (see Fig. 1 ).

The 53-year-old male patient was admitted to the hospital as a result of nucleic acid test confirming COVID-19 in one day of fever. On the sixth day of admission, the patient presented with suffocating, respiratory rate 30 times/min, and CT showed that more than 50% pathological progression, hormone therapy (methylprednisolone 40 mg q12H), high-flow oxygen inhalation (FIO2 50e70%, flow rate 50e60L/min), and symptoms were relieved. After 17 h, the oxygenation index decreased to 92 (FIO2 90%), and noninvasive mechanical ventilation was used. After about 5 h of noninvasive ventilation, the oxygenation index was 82(FIO2 90%). Mechanical ventilation with tracheal intubation was performed, and full sedation and muscle relaxation were performed to adjust ventilator parameters. About 5 h after invasive ventilation, oxygen and index decreased to 66(FIO2 100%), and VeV ECMO implantation was performed. Ventilator management: FIO2 40e90% limit pressure was not more than 30cmH2O, and tidal volume change was observed. The initial tidal volume was 360 ml/min, and it dropped to the lowest level of 17 ml/min on the second day of ECMO transition. At the 8th day of ECMO, it reached the level of 300 ml/min. At the 10th day of ECMO, PEEP12 cmH2O, PC12 cmH2O, tidal volume was more than 500 ml/min. The patient's condition improved, and the ECMO auxiliary conditions were gradually reduced from The 9th day. On the 11th day, the ECMO flow was maintained at 2000 mL/min, the AIR supply of THE ECMO pipeline was stopped, the membrane lung vent was closed, and the variable temperature water tank was closed. The patient was evaluated after 6 h of observation. Chest radiograph showed relatively clear lung field, ventilator condition PEEP10 cmH2O, PC 13 cmH2O,FIO2 40%, RR 20 times/min, tidal volume 550 ml/L level, lung compliance about 35, blood gas analysis PH7.379, PCO2 40.1 mmHg,P02 131 mmHg, LAC 1.3 mmol/L, non-vasoactive drug circulation was maintained well, ultrasound examination of cardiac function was good, right

Asian Journal of Surgery j o u r n a l h o m e p a g e : w w w . e -a s i a n j o u r n a l s u r g e ry . c o m heart dilation was reduced than before, body temperature was 38.1 , intra-abdominal pressure was 11 mmHg, CT examination was not performed due to constraints. Considering that the patient's condition was relatively stable and there was a large room for up-regulation of the ventilator, the observation was not continued, and the ECMO was removed after the experiment was stopped for 7 h. Tracheotomy was performed on the first day after the withdrawal, and ventilator support conditions were gradually reduced, sedation, analgesia and muscle relaxation drugs were removed, and ventilator was successfully removed 24 days after the removal of ECMO. The details of ECMO management and experience discussion were presented in the supplementary materials.

Clinical features of patients infected with 2019 novel coronavirus in Wuhan

Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial

Chest CT examination on the 6th day of admission showed inflammatory changes in the upper and lower lobes of both lungs and the middle lobe of the right lung, and the progression of lung lesions was more than 50%. C. i: Chest radiographs on day 8 of admission (ECMO day 1), ii: Chest radiographs on day 10 of admission (ECMO day 3), iii: Chest radiographs on day 12 of admission (ECMO day 5) iv: Chest radiographs on day 14 of admission

Extracorporeal membrane oxygenation for severe Middle East respiratory syndrome coronavirus Ann

Tianjin Third Central Hospital, China E-mail address: hydtheing@hotmail

Supplementary data to this article can be found online at https://doi.org/10.1016/j.asjsur.2021.12.063.