Implementation of veno-venous extracorporeal membrane oxygenation in a COVID-19 convalescent

Dear Editor,
We would like to present a case of successful implementation of veno-venous extracorporeal membrane oxygenation (ECMO) in a COVID-19 convalescent. Many experts suggest that during a pandemic ECMO should be applied in strictly defined cases for COVID-19 patients, mainly because of the resource-consuming nature of extracorporeal therapy [1, 2]. Current guidelines state that ECMO is contraindicated after seven days of mechanical ventilation, including in critically ill COVID-19 patients [3]. Extracorporeal treatment in our COVID-19 convalescent was launched at the late stage of severe acute respiratory distress syndrome (ARDS), which was also affected by the onset of septic shock. We believe that this is the first case of ECMO therapy in a COVID-19 convalescent to be described in the literature. Written informed consent from the patient was obtained to present this case.
A 28-year old, previously healthy man was referred to the ECMO centre by the Intensive Care Unit (ICU) of the regional hospital. The patient had been mechanically ventilated due to acute respiratory failure for 12 days.
Before admission to the ICU, he had been treated in an isolation ward because of symptoms of dyspnoea, coughing, and fever, which slowly escalated seven days before hospitalization. At the isolation ward, a qualitative antibody IgG/IgM SARS-CoV-2 rapid test was positive, and a viral test from a nasopharyngeal swab (SARS-CoV-2 RT-PCR test) yielded ambiguous results (only nucleocapsid of the virus was detected). The next two viral tests from a nasopharyngeal swab performed were negative.
Because of respiratory deterioration the patient was then transferred to the ICU. Laboratory tests in the ICU on the admission day showed procalcitonin (PCT) of 0.2 mg L-1, C-reactive protein (CRP) of 122 mg L-1, and white blood cells (WBCs) 8.55 G L-1. The SARS-CoV-2 RT-PCR test from bronchoalveolar lavage performed in the ICU was negative, but the quantitative antibody SARS-CoV-2 test revealed an IgG titre of 10.18 (positive value > 1.1) and IgM titre of 2.835 (positive value > 1.1). The epidemiological history of the patient was eminently positive – the rest of his family from the same household had been positively diagnosed with COVID-19. For the above reasons, the patient in the ICU was treated as a COVID-19 convalescent.
In the ICU, the patient was ventilated using a tidal volume below 6 mL kg-1 of predicted body weight, with a high ratio of...


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