Successful Treatment of Refractory Status Asthmaticus With Veno-Venous Extracorporeal Membrane Oxygenation (VV ECMO): A Case Report

Refractory status asthmaticus is an extreme form of asthma exacerbation characterized by hypoxemia, hypercarbia, and secondary respiratory failure and is considered a medical emergency. Mechanical ventilation and maximal medical therapy are often required for treatment, but they frequently fail to provide a resolution. Extracorporeal membrane oxygenation (ECMO), however, has increasingly been used as an unconventional treatment modality if all others fail. Here, we report the case of a 46-year-old male who presented to the emergency department (ED) with shortness of breath. The patient demonstrated signs and symptoms of refractory status asthmaticus with significant wheezing and accessory muscle use on physical exam and failed to respond to maximal therapy, including bronchodilators, high-dose steroids, magnesium sulfate, heliox, noninvasive ventilation, inhaled anesthetics, and mechanical ventilation. Ultimately the patient was placed on veno-venous (VV) ECMO, remained in the intensive care unit (ICU) for seven days, and was discharged to home on day 11 post-ICU admission.