Critical Care: Student/Resident Case Report Poster - Critical Care IV |

Demonstrating the Significance of Immediate Availability of VV-ECMO as a Life Saving Treatment for Status Asthmaticus FREE TO VIEW

Kyle Long, MD; Marina Dolina, MD
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York Hospital, York, PA

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):434A. doi:10.1016/j.chest.2016.08.447
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SESSION TITLE: Student/Resident Case Report Poster - Critical Care IV

SESSION TYPE: Student/Resident Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: Status asthmaticus is a life threatening condition that presents as severe hypercapnic respiratory acidosis. The majority of patients respond to mechanical ventilation and medical management, however severe status asthmaticus can fail traditional management. In these cases, VV-ECMO has shown to reduce mortality. We present several cases of status asthmaticus in which patients were treated with VV-ECMO.

CASE PRESENTATION: Case 1: 29-year-old female with multiple asthma exacerbations admitted with respiratory failure, pH of 6.76 and pCO2 of 152 despite mechanical ventilation. She was emergently placed on VV-ECMO in the ED. During initiation of VV-ECMO patient had cardiac arrest and was resuscitated. Normalization of blood gases was achieved within 2 hours and patient was liberated off VV-ECMO in 4 days. Case 2: 24-year-old man with a history of asthma with no previous intubations suffered a PEA arrest and was resuscitated in the field. On presentation to emergency department had respiratory acidosis with a pH of 6.8, he suffered a second PEA arrest, emergently was started on VV-ECMO, follow-up blood gases showed rapid resolution of acidosis and patient was able to be decannulated within 36 hours of initiation of treatment. Case 3: 28-year-old man with untreated asthma initially presented with worsening SOB symptoms over several weeks. Patient started traditional treatment for asthma exacerbation, but progressed to respiratory failure and was intubated. Initial ABG pH of 7.24 with pCO2 of 44. Despite mechanical ventilation pH decreased to 7.10 with pCO2 of 78. VV-ECMO was initiated and patient had rapid improvement of acidosis and was weaned off VV-ECMO within 48 hours. Case 4: 15-year-old male brought by EMS with ongoing CPR for cardiac arrest, VV-ECMO was immediately started, initial pH of 6.82 and pCO2 of 96. Despite quick return of circulation and complete normalization of blood gases within one hour, our patient sustained anoxic brain death due prolonged CPR prior to arrival to ED.

DISCUSSION: Severe status asthmaticus can become refractory to mechanical support and medical therapy, these cases demonstrate the need for early intervention to prevent progression and if nonresponsive to traditional treatment, the need to initiate VV-ECMO as quickly as possible. ECMO does carry with it risks of serious complications for those undergoing therapy, but the benefits to mortality are so significant to show the necessity of personnel and equipment to initiate this treatment to prevent death.

CONCLUSIONS: Availability of a relatively new technology like VV-ECMO in our institution and the ability of trained personnel to emergently initiate it can save patients lives when they do not respond to maximal medical treatment and mechanical ventilation.

Reference #1: Perfusion. 2014 Jan;29(1):26-8. Extracorporeal carbon dioxide removal for refractory status asthmaticus: experience in distinct exacerbation phenotypes. Brenner K1, Abrams DC, Agerstrand CL, Brodie D.

DISCLOSURE: The following authors have nothing to disclose: Kyle Long, Marina Dolina

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