Critically ill patients with coronavirus disease 2019 (COVID-19)
infection often require
mechanical ventilation, and still many of them will progress to worsening
hypoxia and death. Veno-venous
extracorporeal membrane oxygenation (VV-ECMO) has been used in some centers, but its role in the setting of
COVID-19 infection is still unclear to date. We describe a case of a young female patient with
obesity but otherwise no other underlying medical conditions who was admitted with
respiratory failure secondary to
COVID-19. Given her severe acute respiratory distress syndrome (ARDS) with refractory
hypoxemia, she was treated with VV-ECMO. After a prolonged hospital course, she improved clinically and was able to have VV-ECMO explanted, after 18 days of extracorporeal
therapy. The complexity of ECMO
therapy requires a well-trained multidisciplinary team present only at expert centers. The high resource cost is a challenge to the health care system in times of a global pandemic. Considering the limitations of this resource-intensive
therapy, clinical judgment is crucial to decide whether ECMO is an appropriate option for the patient. However, for young patients with no underlying conditions who are
critically ill despite optimized
mechanical ventilation, we believe that extracorporeal
therapy represents a reasonable option when available.