poreal life support (ECLS), there is no standard policy regarding prophylactic antibiotics for patients on ECLS, including ECPR, because of the lack of studies on infectious complications during ECPR. 12 Therefore, we hypothesized that initiation of ECPR is a risk factor for infectious complications. To address this hypothesis, this observational study examined the association between initiation of ECPR and the incidence of infectious complications, such as pneumonia, sepsis, and bacteremia, in patients with OHCA who received TTM, and also assessed infection management during ECPR. Methods Patients This retrospective study used data from hospital medical records of patients with OHCA treated with TTM who E xtracorporeal cardiopulmonary resuscitation (ECPR) followed by targeted temperature management (TTM) has demonstrated significantly better outcome in patients with out-of-hospital cardiac arrest (OHCA). 1-4 Despite this surprising outcome, however, critical complications, such as infection, hemorrhage, and ischemia, sometimes occur during ECPR management in the intensive care unit (ICU). 5-7 Although a few observational studies did not note a significant association between infection complications and mortality in patients with OHCA or those managed with extracorporeal membrane oxygenation (ECMO), 8,9 and several observational studies examining infection have been conducted in patients with ECPR, 2,5,10,11 the details of infectious complications during ECPR have not been fully examined. According to the Extracorporeal Life Support Organization (ELSO) general guidelines for all extracor

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Introduction The prognosis of mycoplasma pneumonia in adults is generally favorable, but a few patients show progression to acute respiratory distress syndrome (ARDS). We have described the management of a patient who showed progression of mycoplasma pneumonia to ARDS. Presentation of Case A 26-year-old male patient with no significant past medical or social history presented with a 5-day history of fever. Following this, he was diagnosed with bacterial pneumonia and treated with tazobactam/piperacillin; however, he showed little clinical improvement with this treatment approach. We diagnosed the patient with mycoplasma pneumonia with an antigen test and treated him with azithromycin and prednisolone. Despite the appropriate antimicrobial therapy, his symptoms worsened and therefore we changed his oxygen therapy from a reservoir mask to nasal high-flow oxygen in addition to minocycline. Consequently, with this treatment, he recovered from severe mycoplasma pneumonia. Discussion In patients with severe pneumonia who experience respiratory failure, it has been reported that nasal high-flow oxygen therapy is not inferior to noninvasive positive pressure ventilation therapy regarding intubation rate. In this case, induction of nasal high-flow oxygen therapy led to avoidance of ventilator management. This is a valuable case report highlighting the optimal outcome of nasal high-flow oxygen therapy in a fulminant case of acute respiratory distress syndrome. Conclusion In patients who present with severe mycoplasma pneumonia with respiratory failure, nasal high-flow oxygen therapy can help reduce the needs for ventilator management including intubation.