The Use of Extracorporeal Membrane Oxygenation During Acute Chest Crisis in an Adult Sickle Cell Disease Patient: Identification of Pearls and Pitfalls

Tanenbaum, Mira; Shvygina, Anna; Sridhar, Vaishnavi; Vaughn, Jennifer

doi:10.1177/0003134820923346

Cited by 1 publication

(2 citation statements)

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“…10 While trends in the use of or outcomes of ECMO in patients with ACS specifically are not known, there have been a few reports in adults of successful ECMO therapy for ACS. 5,[11][12][13][14][15][16][17][18][19][20][21][22][23] However, in one case series of 22 subjects, mortality was 73% 5 (Table 1). This discrepancy is likely explained in part by publication bias, although could also reflect uncertainties in appropriate ECMO candidacy.…”

Section: Discussionmentioning

confidence: 97%

“…Additionally, advances in ECMO technology have allowed support of sicker patients for longer ECMO durations 10 . While trends in the use of or outcomes of ECMO in patients with ACS specifically are not known, there have been a few reports in adults of successful ECMO therapy for ACS 5,11–23 . However, in one case series of 22 subjects, mortality was 73% 5 (Table 1).…”

Section: Discussionmentioning

confidence: 99%

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Acute chest syndrome from sickle cell disease successfully supported with veno‐venous extracorporeal membrane oxygenation

Grotberg,

Sullivan,

McDonald

et al. 2024

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Sickle cell disease (SCD) affects ~100 000 people in the United States and carries significant morbidity. 1 Under physiologic stresses, such as infection or hypoxemia, red blood cells (RBC) sickle causing vaso-occlusive crisis affecting bones and other organs. In the lung, the pulmonary capillaries are occluded by sickled RBCs (or fat emboli) resulting in a clinical syndrome of fever, pleurisy, hypoxemia, tachypnea, and lung infiltrates called acute chest syndrome (ACS). 2 Roughly, half of patients with SCD will develop ACS and many require intensive care unit (ICU) level care. 3 In severe cases, invasive mechanical ventilation (IMV) is necessary due to secondary lung injury and worsened hypoxemia in a feed-forward cycle (Figure 1). Treatment is supportive including supplemental oxygen, fluids, antibiotics, lung protective ventilation (when intubated), and reduction of sickled hemoglobin (HbS)% via simple RBC transfusion or exchange transfusion. 1,2 Rarely, ACS may progress to severe acute respiratory distress syndrome (ARDS). 4 There are limited data on the use of ECMO for refractory ARDS due to ACS, but those available suggest a high associated mortality. 5 We present a case of severe ARDS secondary to ACS successfully supported with veno-venous (V-V) ECMO. | CASEA 25-year-old male with SCD presented to the emergency department with 4 days of fever, cough, and pleurisy. He displayed hypoxemia (O 2 15 L/min), leukocytosis (15.8 × 10 9 /L), acute-on-chronic anemia (Hb 6.3 g/dL, baseline of 9 g/dL), and thrombocytopenia (93 × 10 9 /L). Percentage of HbS was 77%. A computed tomography scan of the chest demonstrated right lower lobe consolidation. He received antibiotics (vancomycin, cefepime, and azithromycin) and RBC transfusion. However, his respiratory failure rapidly progressed requiring IMV on hospital day (HD) 1. He was transferred to our center for emergent RBC exchange transfusion.Despite improvement in HbS percentage (22.7%), he developed worsening hypoxemia and bilateral infiltrates consistent with severe ARDS, and received paralysis, proning, and inhaled epoprostenol. On HD6, after a bedside positive end-expiratory pressure (PEEP) titration, ventilator settings were as follows: volume assist/control, tidal volume 4.7 mL/ kg ideal body weight, respiratory rate 32, PEEP 10 cmH 2 O, and fraction of inspired oxygen (FiO 2 ) 100%. Plateau pressure was 34 cmH 2 O, driving pressure was 24 cmH 2 O, and static compliance was 12.5 mL/cmH 2 O. Arterial blood gas measured pH of 7.38, carbon dioxide tension (PaCO 2 ) of

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