Novel use of negative pressure ventilation for weaning of venovenous extracorporeal membrane oxygenation

Negative pressure ventilation (NPV) has been used to assist patients with respiratory failure. Venovenous extracorporeal membrane oxygenation (V-V ECMO) supports patients with acute lung injury who do not respond to conventional therapy. Some patients remain on prolonged ECMO support without access to lung transplantation. We report a 40-year-old woman cannulated for V-V ECMO due to refractory hypoxemia (PaO₂/FiO₂ of 58) on hospital day 20 for ARDS from bacteremia and native mitral valve endocarditis. After 108 days, she continued to require ventilator and ECMO support. Applying a negative-pressure Cuirass device in combination with positive pressure ventilation (PPV) improved her carbon dioxide clearance, enhanced overall ventilation/perfusion matching, and facilitated decannulation. Using NPV to assist in V-V ECMO weaning is a novel application of a legacy technology. This case shows NPV as an effective adjunct to PPV for patients on prolonged ECMO support with no other options.