VV-ECMO Support in Acute Respiratory Failure from Occupational Phosgene Gas Exposure: A Case Report

A 56-year-old male with no antecedent respiratory disease developed acute respiratory failure following workplace exposure to phosgene gas (COCl₂), a toxic industrial compound known for its pulmonary toxicity. He developed refractory hypoxemia, was transferred to our facility, and was promptly placed on venovenous extracorporeal membrane oxygenation (VV-ECMO). The patient was successfully supported through the acute lung injury and recovery phase and was discharged from the hospital within 16 days without supplemental oxygen. To our knowledge, this is the first known case in the United States of the use of ECMO in the treatment of phosgene gas exposure. Currently, there are few evidence-based therapeutic options available for phosgene gas exposure; however, it is suggested that supportive care may allow for physiological recovery. Previous reports have suggested that VV-ECMO can improve survival in cases of treatment-resistant hypoxemia.