[Extracorporeal membrane oxygenation for acute respiratory failure induced by Legionella pneumoniae. (Case report)]

We report a case of severe legionella pneumonia with acute respiratory failure, successfully managed with veno-venous extracorporeal membrane oxygenation (VV-ECMO). The patient presented with 4-day history of fever and cough. He was in critical condition, with exacerbated respiratory failure. Mechanical ventilation, volume replacement and antibiotic therapy were initiated. Despite increasing mechanical ventilatory support (FiO2 100%, TV 10 ml/kg, f 30/min, PEEP 5 cmH20), PaO2 fell below 40Torr and life sustaining measures were undertaken. VV-ECMO (flow 30 ml/kg/min) was commenced, and the patient responded well, with an elevation of PaO2. Erythromycin therapy was effective against the pneumonia. VV-ECMO was maintained for 92 hours, mechanical ventilation was successfully discontinued 11 days after and the patient was discharged 82 days after cessation of ventilator support. Serum antibody examination proved legionella infection. VV-ECMO may have a role in the management of patients with acute respiratory failure caused by bacterial pneumonia.