Successful Management of Status Asthmaticus via Veno-Venous ECMO: Extubation Prior to Decannulation-A Case Report

The use of veno-venous extracorporeal membrane oxygenation (VV-ECMO) has risen exponentially since the COVID pandemic. VV-ECMO has been utilized successfully to manage patients in status asthmaticus who have failed to respond adequately to conventional therapeutic interventions and mechanical ventilatory support. However, clear guidelines on the management of mechanical ventilation for these patients while on VV-ECMO support appear to be lacking.

A 52-year-old male was placed on emergent VV-ECMO for status asthmaticus after developing worsening hypercarbic respiratory failure despite mechanical ventilation and aggressive bronchodilator therapy. Once he was stabilized on VV-ECMO, there was a dilemma in management priorities-extubate the patient while keeping full VV-ECMO support versus working to aggressively wean VV-ECMO support while the patient is intubated. Ultimately, the decision was made to extubate the patient about 60 h postcannulation. Postexubation, however, he was in respiratory distress with stridor and worsening bronchospasm and required maximum sweep on the VV-ECMO in addition to increased respiratory support via noninvasive ventilation (NIV). Ultimately, he turned the corner, made progressive improvement, was weaned from VV-ECMO support, and was decannulated 7 days after cannulation.

Extubating a patient placed on VV-ECMO for status asthmaticus is not a straightforward decision. One needs to consider the management priorities, anticipate the potential problems, and understand the implications of early extubation.