Ecmo in a diabetic patient with cerebellar infarction and ARDS- A case report

Extra corporeal membrane oxygenation (ECMO) has been considered as a crucial modality for the management of acute respiratory distress syndrome (ARDS). Since ECMO is considered to be an invasive modality and may be associated with some complications, there are strict indications for its use. Here we report successful treatment of a case of severe ARDS with Veno-Venous ECMO.

A 30 years old male was admitted to Nemazee Hospital in Shiraz with decreased level of consciousness due to cerebral hemorrhage following fibrinolytic therapy for myocardial infarction with ST elevation (STEMI).  After diagnosis of moderate to severe ARDS, VV-ECMO was used for the management of ARDS.
In this case, 5 days after starting ECMO, PaCO2 improved and O2Sat was maintained at 97-98%, so weaning was considered.  Ventilator mode was BIPAP with FiO2 40% and sweep flow was 1.7L/min. We clamped the sweep flow and observed whether the patient was able to maintain O2 Sat at 97% with ventilation alone. Then, we decided to disconnect the patient from ECMO. The patient remained stable afterwards.

Our case was intubated and was on MV from 10 days prior to ECMO administration.Moreover, our patient had simultaneous multi-organ involvement (nephrotic syndrome and sepsis) which decreased the benefits of ECMO. Despite all these problems, ECMO was started and patient was discharged from ICU with an acceptable health condition.