Near-fatal asthma is a life-threatening condition characterized by severe airflow obstruction, refractory hypercapnia, and respiratory acidosis. Although invasive mechanical ventilation is often required, it carries significant risks, including barotrauma, dynamic hyperinflation, and hemodynamic compromise. In selected cases, extracorporeal membrane oxygenation (ECMO) can be used as a rescue therapy when conventional management fails. We report the case of a 19-year-old woman with near-fatal asthma who developed refractory respiratory acidosis and severe barotrauma despite maximal medical therapy and invasive mechanical ventilation. She presented with profound hypoxemia, with an oxygen saturation of 64% on room air. Due to persistent acidosis and hemodynamic instability, veno-venous ECMO was initiated as a salvage therapy. Immediately before ECMO initiation, arterial blood gas analysis showed severe acidosis with pH 7.00, partial pressure of carbon dioxide (PaCO2) 115 mmHg, and lactate 14 mmol/L. Within 12 hours of ECMO initiation, pH improved to 7.30, PaCO2 decreased to 49 mmHg, and lactate fell to 2.0 mmol/L, with concurrent hemodynamic stabilization. The patient showed marked clinical improvement and was successfully weaned from ECMO after four days and later liberated from mechanical ventilation following tracheostomy. This case highlights VV-ECMO as a viable rescue strategy in carefully selected patients with refractory near-fatal asthma when conventional ventilation fails or risks further ventilator-induced lung injury.
Haque et al. (Tue,) studied this question.