15: Successful Utilization of VV-ECMO in Severe Smoke Inhalation: A Life-Saving Intervention for a 17-Year-Old.

Background: Extracorporeal membrane oxygenation (ECMO) can serve as a critical rescue therapy for patients suffering from burn and smoke inhalation-induced respiratory distress (1). Pulmonary complications often emerge as the leading cause of death in these patients. Case Report: A 17-year-old patient with no prior medical history presented with severe smoke inhalation from a closed room incident, exhibiting no skin burns. Upon admission, the patient displayed severe metabolic acidosis, a lactate level of 10 mmol/L, COHb at 21%, and significant hypoxia. Despite being ineligible for hyperbaric oxygen therapy, the patient showed signs of carbon monoxide and cyanide poisoning, and acute respiratory distress syndrome (ARDS) secondary to smoke inhalation. Sodium thiosulphate was administered for cyanide poisoning. Following intubation, lung protective ventilator settings were employed, and proning was initiated. However, the patient’s condition remained critical, prompting the initiation of VV-ECMO. Under aseptic conditions, right femoro-jugular cannulation was performed with 26Fr and 22Fr cannulae for access and return, respectively. The ECMO flow achieved a maximum of 4.7 liters with a sweep of 5 liters. The patient remained on ECMO for a total of 9 days and was successfully discharged from the ICU two days post-ECMO decannulation. Conclusion: This case underscores the life-saving potential of VV-ECMO in managing severe smoke inhalation injuries, demonstrating its effectiveness when conventional therapies fail