Extracorporeal membrane oxygenation (ECMO) for near-fatal asthma refractory to conventional ventilation. (20th March 2018)

• Record Type: Journal Article
• Authors: Maqsood, Usman; Patel, Nehal
• Is Part Of: BMJ case reports. Volume 2018
• Publication Date: 2018-03-20
• Subjects: asthma -- mechanical ventilation; Medicine -- Case studies -- Periodicals; 610.5
• DOI: 10.1136/bcr-2017-223276
• Languages: English
• ISSNs: 1757-790X

Abstract

Abstract : We describe a case of near-fatal asthma, treated successfully by initiation of extracorporeal membrane oxygenation (ECMO). A 29-year-old woman, known asthmatic on steroid inhalers, inhaled/nebulised bronchodilators, long-term oral prednisolone, theophylline and montelukast, presented with acute shortness of breath. She deteriorated following initial treatment with nebulised bronchodilators and magnesium sulfate requiring intubation and mechanical ventilation. Severe bronchospasm ensued following mechanical ventilation and peak airway pressures remained at 55 cm H2 O with intrinsic positive end expiratory pressure(PEEP) of 14 cm H2 O. Despite treatment with sedation, paralysis, intravenous salbutamol and inhaled sevoflurane, her condition deteriorated. She was commenced on mobile ECMO by the retrieval team. While on ECMO, her CO2 normalised within 48 hours. She was extubated within 72 hours of initiating ECMO and was discharged to the ward next day. We reiterate that ECMO should be considered sooner for status asthmatics not responding to maximal pharmacological therapy and ventilatory support to prevent ongoing lung injury and mortality.