10: Modifications to ECLS Strategies to Achieve Positive Outcomes in Chronic Lung Disease

Background: In patients with irreversible lung disease, particularly those awaiting lung transplantation, VV-ECMO can serve as a bridge to transplantation or a stabilizing therapy during acute exacerbations. Long-term (VV-ECMO) with good outcomes is rare but possible in certain cases, especially with advanced critical care settings. This case highlights the potential for recovery even after prolonged VV-ECMO support, emphasizing the need for persistence and hope in managing patients with irreversible chronic lung diseases. Case Description: A 24-year-old female with a past medical history of Fanconi anemia post-bone marrow transplant, underweight, with spinal scoliosis and bronchiectasis, who was a candidate for lung transplant, presented with severe respiratory symptoms and signs,confirmed covid 19 positive. She was initially managed in ward but due to worsening of respiratory acidosis, she was transferred to the intensive care unit with initiation of mechanical ventilation. There was no significant improvement, necessitating the initiation of ECCO2R.The patient developed NSTEMI with impaired systolic function and was supported with inotropes and vasopressors. Although her cardiovascular status improved, her respiratory parameters continued to deteriorate with resistant hypoxemia. Her ECCO2R was converted to VV-ECMO using a double-lumen cannula. The patient’s condition improved, and she successfully weaned from mechanical ventilation. Unfortunately, due to persistent hypercapnia, she continued to require 2 L of FGF. She then experienced significant necrosis and probable infection at the cannula site. As a result, her VV ECMO was switched to ECCO2R to better control CO2 levels. After 13 additional days, totaling 56 days on alternating different modes of ECMO, the patient showed progressive improvement and was finally decannulated and discharged from the ICU to the ward on Day 60. Conclusion: The proper planning with use of different ECLS strategies and modes according to the changes in pathophysiology of the disease will result in positive outcome