Awake extracorporeal membrane oxygenation in a patient with COVID-19 pneumonia and severe hypoxemic respiratory failure

A. Soroksky, M. Tocut, Z. Rosman, H. Dekel

Intensive Care Unit, Department of Medicine, Department of Cardiothoracic Surgery; Wolfson Medical Center; The Center for Autoimmune Diseases, Sheba Medical Center; Sackler Faculty of Medicine, Tel-Aviv University, Israel. milena.tocut@gmail.com

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• Infectious Diseases
• Respiratory Medicine

OBJECTIVE: In the past few years, extracorporeal membrane oxygenation (ECMO) has been increasingly used in patients with severe respiratory insufficiency in whom mechanical ventilation (MV) had failed. MV in severe COVID-19 patients is often accompanied by high respiratory pressures and high oxygen concentrations. Thus, by “placing the lungs at rest” ECMO might spare severe COVID-19 patients from being subjected to aggressive MV. Awake ECMO is another therapeutic alternative for providing extracorporeal oxygenation and ventilation by avoiding the complications of MV.

CASE PRESENTATION: A 65-year-old male diagnosed with COVID-19 pneumonia was admitted to the intensive care unit (ICU) after deteriorating to hypoxemic respiratory failure with acute respiratory distress disorder (ARDS).

Awake veno-venous (VV) ECMO was considered after receiving patient consent and was successfully implemented as an attempt to avoid invasive MV. This is one of the first cases described during the COVID-19 pandemic, in which awake VV-ECMO was used in a critically ill COVID-19 patient as a replacement therapy to conventional MV.

CONCLUSIONS: Under the appropriate conditions, awake ECMO might be a suitable alternative approach to avoid complications of aggressive MV in selected critically ill COVID-19 ARDS patients.

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