Management of inhalational injury secondary to prolonged anhydrous ammonia exposure with venovenous ECMO: A case report

Ammonia is one of the most commonly produced chemicals in the world, with uses in agriculture, household cleaning, and as an alternative fuel source. While typically encountered in low concentrations, pure anhydrous ammonia in its gaseous form is extremely toxic and a potent caustic. We report the case of a previously healthy 19-year-old with prolonged anhydrous ammonia exposure after a motor vehicle accident caused an inadvertent release of 4000 gallons of anhydrous ammonia. Despite optimal initial medical management, he required venovenous extracorporeal membrane oxygenation (VV-ECMO) in addition to aggressive multispecialty care to address his extensive injuries. After a prolonged hospitalization, he recovered without the need for lung transplantation and returned to activities of daily living. This case highlights the fastidious care necessary to effectively treat those exposed to anhydrous ammonia, including VV-ECMO as a salvage technique.