Use of Double-Parallel Oxygenators for Hypercapnia During Veno-Venous Extracorporeal Membrane Oxygenation: A Case...

A 76-year-old man arrived at our hospital post-intubation for coronavirus disease, and veno-venous extracorporeal membrane oxygenation (V-V ECMO) was performed for hypoxemia the same day. Although renal replacement therapy was introduced for anuria due to bacterial pneumonia, the patient became fluid-overloaded. In addition to the effects of fluid overload and pneumonia, the ventilator was adjusted to a lung rest strategy, making oxygen delivery and carbon dioxide (CO₂) removal almost entirely dependent on ECMO. Even with high-flow sweep gas, CO₂ removal was difficult because of the relatively large body surface area, hypercapnia renal compensation difficulties due to acute kidney injury, increased CO₂ production because of infection, and increased membrane lung shunting secondary to blood coagulation disorders. Therefore, we used double-parallel oxygenators for the hypercapnia and reduced the sweep-gas flow because of the increased membrane lung area. These results suggest that double-parallel oxygenator use provides effective management for refractory hypercapnia during ECMO.