Venovenous Extracorporeal Membrane Oxygenation (ECMO) as a Life-Saving Intervention in Refractory Status Asthmaticus: A Case Report

Acute severe asthma, or status asthmaticus, is a life-threatening condition unresponsive to conventional therapies such as inhaled β-agonists, corticosteroids, and non-invasive ventilation. We report a case of a 41-year-old male with refractory bronchospasm and profound respiratory acidosis despite aggressive medical management. Initial extracorporeal CO₂ removal (ECCO₂R) via a continuous renal replacement therapy (CRRT) system was unsuccessful due to blood flow limitations. The patient was transitioned to venovenous extracorporeal membrane oxygenation (VV ECMO), which led to rapid improvement in gas exchange and stabilization of dynamic hyperinflation. Over the next several days, bronchospasm resolved, ventilator settings were optimized, and the patient was successfully weaned off ECMO and extubated. This case highlights the critical role of extracorporeal therapies, particularly VV ECMO, in managing severe asthma exacerbations refractory to conventional treatment, allowing lung rest and improving outcomes. Emerging evidence supports the efficacy of these modalities, warranting further research to standardize their use in status asthmaticus.