Acute Med Surg . A successful case of extracorporeal membrane oxygenation treatment for intractable pneumothorax in a patient with COVID-19

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Acute Med Surg


. 2020 Dec 9;7(1):e612.
doi: 10.1002/ams2.612. eCollection Jan-Dec 2020.
A successful case of extracorporeal membrane oxygenation treatment for intractable pneumothorax in a patient with COVID-19


Keita Nakatsutsumi ¹ , Kosuke Sekiya ¹ , Nao Urushibata ¹ , Marie Hosoi ¹ , Hirokuni Arai ² , Eiki Nagaoka ² , Tatsuki Fujiwara ² , Koji Morishita ¹ , Junichi Aiboshi ¹ , Yasuhiro Otomo ¹



Affiliations

• PMID: 33318806
• PMCID: PMC7725136
• DOI: 10.1002/ams2.612

Abstract

Background: Some patients with coronavirus disease 2019 (COVID-19) develop pneumothorax. Tube thoracotomy and bulla resection could generate aerosols and cause virus transmission; the optimal treatment strategy remains unclear.
Case presentation: A 57-year-old male was transferred as a severe COVID-19 pneumonia case. On the 16th day after admission, the patient's respiratory condition deteriorated, and the chest X-ray revealed the presence of severe right-sided pneumothorax. A chest drain was immediately inserted; however, a significant air leak continued, and severe ventilator settings were required. Thus, veno-venous extracorporeal membrane oxygenation (VV-ECMO) treatment was initiated to allow the lungs to rest. After 10 days of lung-protective ventilation, the patient was weaned from ECMO and the chest drain was removed on the following day with no major comorbidities.
Conclusion: The combination of ECMO with lung rest strategy could be a treatment option for intractable pneumothorax with COVID-19 to avoid unnecessary surgical procedures and aerosol generation.

Keywords: Acute respiratory distress syndrome; COVID‐19; aerosols; extracorporeal membrane oxygenation; pneumothorax.