0
Critical Care |

Extracorporeal Membrane Oxygenation - Rescue Therapy for Status Asthmaticus

Narendrakumar Alappan*, MD; Lewis Eisen, MD; William Jakobleff, MD; Ariel Shiloh, MD
Author and Funding Information

Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY


Chest. 2012;142(4_MeetingAbstracts):319A. doi:10.1378/chest.1388758
Text Size: A A A
Published online

Abstract

SESSION TYPE: Critical Care Case Report Posters

PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM

INTRODUCTION: Status asthmaticus is a life-threatening condition characterized by progressive respiratory failure due to asthma that may be unresponsive to standard therapeutic measure1. We describe a patient with status asthmaticus refractory to conventional medical therapy and ventilator management, who was rescued with timely use of extracorporeal membrane oxygenation therapy (ECMO).

CASE PRESENTATION: A 23 year old male, non -smoker, with the past history of mild intermittent asthma presented to the emergency department for exacerbation of asthma precipitated by an upper respiratory syndrome. His asthma symptoms had been previously controlled by as needed use of MDI albuterol alone. There was no history of hospitalization or intubation for asthma. Despite aggressive therapy with continuous albuterol, terbutaline, subcutaneous epinephrine, and high dose steroids, his symptoms progressed. He was intubated and transferred to the intensive care unit where he was sedated, paralyzed, and continued on mechanical ventilation. Chest radiograph showed severe hyperinflation. With recommended ventilator settings for status asthmaticus (low respiratory rate, low tidal volume, and prolonged expiratory phase) he remained extremely difficult to ventilate, generating high peak pressure (49cmH2O) and significant intrinsic PEEP (18cmH2O). Serial blood gases revealed worsening respiratory acidosis (pH 6.95: pCo2 112mmHg). Cardiothoracic surgery was consulted to initiate veno-venous ECMO (Avalon, 27 F Bi-Caval Dual lumen cannulated via the internal jugular vein and using a Quadrox D poly-methylpentene oxygenator). With ECMO, the respiratory acidosis gradually improved over the next few hours and mechanical ventilator settings were set at lung rest mode, with low tidal volumes. With continued use of steroids and inhaled bronchodilator therapy, the bronchospasm improved. ECMO was discontinued on hospital day two and patient was extubated on hospital day four.

DISCUSSION: Extracorporeal life support has been used as salvage therapy for adults with acute respiratory failure since 1972. Status asthmaticus, a potentially fatal but reversible process represents a disease which could benefit from extracorporeal gas exchange when standard measures have failed. Evidence supporting the use of ECMO in refractory status asthmaticus is lacking, and only a few case reports exist. Novel modalities like pECLA( pumpless extracorporeal lung assist) are being increasingly utilized in similar acute respiratory failures.

CONCLUSIONS: The application of extracorporeal gas exchange can be lifesaving in refractory status asthmaticus.

1) Cohen NH, Eigen H, Shaughnessy TE. Status asthmaticus. Crit Care Clin. 1997 Jul;13(3):459-76. Review. PubMed PMID: 9246526.

DISCLOSURE: The following authors have nothing to disclose: Narendrakumar Alappan, Lewis Eisen, William Jakobleff, Ariel Shiloh

No Product/Research Disclosure Information

Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543