Use of venovenous (VV) extracorporeal membrane oxygenation (ECMO) in near-fatal asthma: a case series

Ciro D. Ibarra, S. Sangiovanni, D. F. Bautista, C. A. Calderón-Miranda, Gustavo A. Cruz, L. Fernández-Trujillo
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Abstract

Introduction: Status asthmaticus (SA) and near-fatal asthma (NFA) are life-threatening conditions that continue to present a management challenge for physicians. Extracorporeal Membrane Oxygenation (ECMO) has been employed as a last resort in treating these patients. Case presentation: We described six patients who were admitted to the ICU for near-fatal asthma (NFA) and received ECMO treatment at a high-complexity institution in Cali, Colombia, between 2015 and 2019. All patients are registered in the ELSO registry. Baseline patient characteristics, arterial blood gases (ABG), ventilatory parameters, and complications were collected as specified in the ELSO registry form. Efficacy was analyzed in terms of the improvement in respiratory acidosis, the number of ventilator-free days (VFD), and a reduction in mechanical power (MP). MP, which refers to the energy associated with the mechanical forces involved in breathing and the functioning of the respiratory system, was calculated using a mathematical formula. Safety was evaluated based on the incidence of complications. After 12 hours of ECMO, we achieved a correction of respiratory acidosis, a significant decrease in all ventilatory parameters, and a reduction in MP ranging from 52.8% to 89%. There was one mortality. Among the five surviving patients, all except one, who required a tracheostomy, had a high VFD score, with a mode of 26 days, demonstrating a reduction in ventilation time. Conclusion: Further randomized controlled trials are needed to fully understand the efficacy and safety profiles of ECMO in SA/NFA. MP is being widely used to achieve safer ventilation, and although more data is required, it appears to be a promising option for evaluating the risk of developing VILI and the success of the therapy.
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在濒死哮喘患者中使用静脉(VV)体外膜肺氧合(ECMO):一个病例系列
导言:哮喘状态(SA)和濒死性哮喘(NFA)是威胁生命的疾病,一直是医生面临的管理难题。体外膜肺氧合(ECMO)一直是治疗这些患者的最后手段。病例介绍:我们描述了 2015 年至 2019 年间因濒死哮喘(NFA)入住重症监护室并在哥伦比亚卡利市一家高复杂性机构接受 ECMO 治疗的六名患者。所有患者均在 ELSO 登记处登记。按照ELSO登记表的规定收集了患者的基线特征、动脉血气(ABG)、通气参数和并发症。疗效根据呼吸性酸中毒的改善情况、无呼吸机天数(VFD)和机械功率(MP)的降低情况进行分析。MP 是指与呼吸和呼吸系统功能所涉及的机械力相关的能量,通过数学公式计算得出。安全性根据并发症的发生率进行评估。ECMO 12 小时后,我们纠正了呼吸性酸中毒,所有通气参数均显著下降,MP 下降了 52.8% 至 89%。有一名患者死亡。在五名存活的患者中,除了一名需要进行气管切开术外,其他患者的 VFD 评分都很高,模式为 26 天,这表明通气时间缩短了。结论需要进一步开展随机对照试验,以充分了解 ECMO 在 SA/NFA 中的疗效和安全性。MP 正被广泛用于实现更安全的通气,虽然还需要更多的数据,但它似乎是评估 VILI 发生风险和治疗成功率的一个很有前景的选择。
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Use of venovenous (VV) extracorporeal membrane oxygenation (ECMO) in near-fatal asthma: a case series Use of venovenous (VV) extracorporeal membrane oxygenation (ECMO) in near-fatal asthma: a case series
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