Extracorporeal Membrane Oxygenation for Treatment of Immune Checkpoint Inhibitor-Related Pneumonia Complicated with Severe ARDS: A Case Report

Yanfei Meng, Yamin Yuan, Li Ma, Jiaqi Wang, Bei Zhang Department of Critical Care Medicine, Lanzhou University Second Hospital, Lanzhou University, Lanzhou City, Gansu Province, People’s Republic of ChinaCorrespondence: Bei Zhang, Email [email protected]: This paper utilizes a retrospective analysis to examine the diagnostic and therapeutic processes for a patient afflicted with immune-related pneumonia, which was complicated by severe acute respiratory distress syndrome (ARDS) and was triggered by Tirellizumab following a surgical procedure for a pulmonary malignancy. The patient exhibited unimproved oxygenation levels, which resulted from the implementation of a lung protective ventilation strategy through invasive mechanical ventilation during the early stages of treatment. Consequently, we opted to perform veno-venous extracorporeal membrane oxygenation (ECMO). Complications such as catheter-related infection, hemolysis, and membrane thrombosis occurred during the period under investigation. After the implementation of awake VV-ECMO, there were still difficulties in withdrawing the ventilator, and the disease was identified again and clearly diagnosed as immune checkpoint inhibitor-related pneumonia. Finally, after standardized treatment, the patient exhibited improvement. For patients with severe ARDS who have received invasive mechanical ventilation, It is imperative to standardize lung protective ventilation strategies, and to allow prone position ventilation under specific conditions. In cases where oxygenation remains unimproved, the selection of extracorporeal membrane oxygenation (ECMO) should be guided by cardiac function, with a concomitant understanding of the associated complications and management strategies. Furthermore, it is essential to thoroughly assess the benefits and drawbacks of awake ECMO, and to develop the capacity to discern diseases associated with fever and lung shadow for the purpose of precise treatment.Keywords: awake VV-ECMO, checkpoint inhibitor-associated pneumonia, acute respiratory distress complex signs, lung protective ventilation strategy