Authors: Mikkelsen, Mark E.¹; Pugh, Meredith E.¹; Hansen-Flaschen, John H.¹; Woo, Y Joseph²; Sager, Jeffrey S.¹

Source: Respiratory Care, Volume 52, Number 11, November 2007 , pp. 1525-1529(5)

Publisher: The Journal Respiratory Care Company

Abstract:

We report a case of successful use of extracorporeal life support (ECLS) as salvage treatment in an adult with acute, severe, reversible respiratory failure due to asphyxic status asthmaticus. Conventional measures were ineffective to combat the dynamic hyperinflation; the patient had intrinsic positive end-expiratory pressure > 30 cm H₂O. We initiated emergency ECLS at the bedside, and after 55 hours of ECLS his respiratory mechanics had markedly improved and he was subsequently weaned off of ECLS and decannulated, without vascular, pulmonary, or neurologic complications. This article reviews the history of ECLS for adult respiratory failure and its application for life-threatening status asthmaticus. This case illustrates the effective use of ECLS for acute respiratory failure due to asphyxic status asthmaticus, and to our knowledge is the first reported case in which the patient's impending cardiopulmonary arrest was due to an unsustainable level of intrinsic positive end-expiratory pressure.

Keywords: EXTRACORPOREAL LIFE SUPPORT; STATUS ASTHMATICUS; MECHANICAL VENTILATION; INTRINSIC POSITIVE END-EXPIRATORY PRESSURE; PEEP; DYNAMIC HYPERINFLATION

Document Type: Case report

Affiliations: 1: Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania Health System, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, Pennsylvania 2: Division of Cardiothoracic Surgery, University of Pennsylvania Health System, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, Pennsylvania

Publication date: 2007-11-01

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