Successful management of acute respiratory distress syndrome secondary to type A aortic dissection using venovenous oxygenation: A case report

Introduction Type A aortic dissection (AD) rarely coexists with acute respiratory distress syndrome (ARDS). Venovenous (VV) extracorporeal membrane oxygenation (ECMO) is avoided owing to bleeding and dissection progression concerns. Case Report A 49-year-old man presented with sudden onset of chest pain and dyspnea. Computed tomography findings did not indicate rupture or malperfusion in Type A AD. He developed severe ARDS refractory to lung-protective ventilation and recruitment maneuvers. VV-ECMO was initiated with nafamostat anticoagulation, with temporary continuous hemodiafiltration for fluid balance. Oxygenation improved, allowing ECMO removal on Day 14. After tracheostomy, he was discharged from the ICU on Day 49 and mechanically ventilated without AD progression. Discussion VV-ECMO can stabilize gas exchange without exacerbating AD in select patients with ARDS when perioperative risk outweighs the immediate risk of rupture or organ malperfusion. Conclusion VV-ECMO may be considered for ARDS complicated AD when the bleeding risk is mitigated by regional anticoagulation.