Veno-venous ECMO for hypoxemic and hypercapnic respiratory failure in obese patient

A case of successful application of veno-venous extracorporeal membrane oxygenation (ECMO) for hypoxemic and hypercapnic respiratory failure secondary to severe pneumonia in a patient with concomitant bronchial asthma and morbid obesity (BMI = 51 kg/m²) is presented. Due to the ineffectiveness of standard intensive care measures, veno-venous ECMO was initiated on day 6 of the ICU stay and on day 16 of illness onset. The criteria for initiating veno-venous ECMO were hypoxemic (PaO₂/FiO₂ ratio 68) and hypercapnic (respiratory acidosis, pH 7.13) respiratory failure. Positive clinical dynamics were observed from day 4 of ECMO, as evidenced by improvements in lung mechanics, gas exchange, and chest radiographic findings. On day 8 of ECMO, the patient successfully passed a weaning trial, allowing ECMO discontinuation and decannulation. Thereafter, particular attention was paid to gradual patient mobilization and weaning from respiratory support. On day 14 after ECMO cessation, the tracheostomy tube was removed; on day 26, the patient was transferred to a general ward. The successful outcome in this patient was attributed to comprehensive intensive care, with the use of ECMO and timely adjustment of antibacterial therapy playing a key role. In this article, using a presented clinical case as an example, the features of intensive care management in patients with morbid obesity, the specifics of obesity physiology and pathophysiology are discussed, and examples of survival studies in this patient category are provided. The results of these studies confidently indicate that obesity should be considered an additional risk factor rather than a contraindication to ECMO.