Use of Venovenous Extracorporeal Membrane Oxygenation in Status Asthmaticus: Case Reports

Bronchial asthma remains one of the most common chronic respiratory diseases characterized by episodes of severe airway obstruction. In cases of refractory status asthmaticus complicated by critical hypercapnia and decompensated respiratory acidosis, conventional methods of respiratory support, including mechanical ventilation, are often insufficient. The use of venovenous extracorporeal membrane oxygenation (VV-ECMO) is considered a promising method for stabilizing gas exchange and minimizing ventilator-induced damage. Objective: to share clinical experience in successful use of VV-ECMO in patients with refractory status asthmaticus complicated by severe hypercapnia and decompensated respiratory acidosis, resistant to correction by conventional respiratory support and lung-protective ventilation. Materials and methods. VV-ECMO was used as an extracorporeal alternative for lung gas exchange function in two female-patients with refractory status asthmaticus complicated by severe hypercapnia and decompensated respiratory acidosis. Results. VV-ECMO reduced the risk of developing ventilator-induced lung injury (VILI) allowing maintenance of lung-protective mechanical ventilation, and therefore, enabling accelerated respiratory rehabilitation. In both presented cases, early initiation of VV-ECMO improved gas exchange parameters and mitigated ventilator-associated complications, thereby confirming the relevance of its’ use in patients with severe exacerbations of bronchial asthma complicated by uncontrolled hypercapnia. Conclusion. Presented experience highlights the importance and feasibility of further VV-ECMO exploration as an intensified approach for management of severe BA exacerbations accompanied by critical hypercapnia and respiratory failure. This might require larger-scale randomized trials to identify optimal indications and protocols for VV-ECMO use.