Case Report: When Enough is not Enough… Treating Refractory Hypoxemia

Abstract

Herein we report a case of a 43 year old immunocompromised male, post renal transplant, with Adult Respiratory Distress Syndrome (ARDS), secondary to Severe acute respiratory syndrome coronavirus 2 (SARS-COV-2), who required Veno-Venous Extra Corporeal Membrane Oxygenation (VV ECMO), with the unique configuration of double oxygenators.

Despite invasive ventilatory support and maximum conventional VV ECMO support, he had persistent refractory hypoxemia. At this point, it was deemed necessary to attempt an adjuvant intervention to improve his oxygenation and hence the decision was made, to add another oxygenator to the existing ECMO circuit. His oxygenation parameters improved after the addition of the second oxygenator.The patient improved gradually and we continued to wean his ECMO settings. He was eventually DE cannulated after 34 days on ECMO.

We believe that this is the first case where two oxygenators were placed in parallel, in a single circuit, for a SARS COV-2 patient with refractory hypoxemia. The addition of an oxygenator in parallel was successful in improving oxygenation and more importantly allowed us to continue with ultra-protective lung ventilation.

The patient provided informed consent for scientific publication