Extracorporeal membrane oxygenation for refractory acute respiratory distress syndrome in severe malaria

Abstract

BackgroundSevere malaria may be complicated by the acute respiratory distress syndrome (ARDS), which is associated with a high mortality. In the present report, a series of three cases of imported malaria complicated by refractory severe ARDS supported with extracorporeal membrane oxygenation (ECMO) is presented.MethodsOne female and two male adult patients (ages 39 to 53) were included. Two patients had Plasmodium falciparum infection and one patient had Plasmodium vivax and Plasmodium ovale co-infection. Anti-malarial therapy consisted in intravenous quinine (in two patients) and intravenous quinidine (in one patient), plus clindamycin or doxycycline.ResultsDespite lung protective ventilation, a conservative strategy of fluid management, corticosteroids (two patients), prone position (two patients) and inhaled nitric oxide (one patient), refractory severe ARDS supervened (PaO2 to FiO2 ratio 68) and venovenous ECMO was then initiated. In one patient, a bicaval dual-lumen cannula was inserted; in the two other patients, a two-site configuration was used. Two patients survived to hospital-discharge (duration of ECMO support: 8.5 days) and one patient died from nosocomial sepsis and multi-organ failure after 40 days of ECMO support.ConclusionsECMO support allowed adequate oxygenation and correction of hypercapnia under lung protective ventilation, therefore reducing ventilator-induced lung injury. ECMO referral should be considered early in malaria complicated by severe ARDS refractory to conventional treatment.

Extracorporeal membrane oxygenation (ECMO) as salvage treatment for pulmonary Echinococcus granulosus infection with acute cyst rupture

“…This case describes the use of ECMO as salvage treatment for severe respiratory insufficiency due to pulmonary E. granulosus infection with acute cyst rupture and bacterial superinfection, possibly for the first time. ECMO has been used widely as a treatment modality for severe respiratory failure and ARDS due to viral (e.g., influenza A) and bacterial diseases (e.g., pneumococcal pneumonia), as well as malaria (Alves et al, 2013). However, no previous reports on its use in respiratory failure due to helminthic diseases could be identified in the literature.…”

Intravenous Artesunate for the Treatment of Severe and Complicated Malaria in the United States: Clinical Use Under an Investigational New Drug Protocol

“…Exceptions were patients with ARDS, acute renal failure, or abnormal bleeding, all of which are malaria complications that carry an extraordinary risk for poor outcomes (41, 42). Given that fact, these patients would not be expected to recover quickly.…”

Varicella associated acute respiratory distress syndrome in an adult patient: an example for extracorporeal respiratory support in Brazilian endemic diseases

“…It is interesting to note that the ECMO support that is described in the literature was in patients who emigrated from low-middle income regions to high-income regions, likely reflecting the cultural - economical incapacity of low-middle income countries to control the disease or to offer adequate support for the victims of severe malaria. ( 21 , 22 )…”