Oxygen Support Therapy VV-ECMO ‘Feasible’ in CAD Patients: Report

The technique was used to treat a man, 64, with severe COVID-19 infection

Marisa Wexler, MS avatar

by Marisa Wexler, MS |

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VV-ECMO, a technique used to deliver oxygen to the body when the lungs are not working properly, can be used in people with cold agglutinin disease (CAD) without notable complications, a case report shows.

The report, “Veno-venous extra-corporeal membrane oxygenation in a COVID-19 patient with cold-agglutinin haemolytic anaemia: A case report,” was published in Perfusion.

Veno-venous extra-corporeal membrane oxygenation, or VV-ECMO, involves using a machine as an “artificial lung.” The machine is connected to a patient’s bloodstream and transfers oxygen from the air into the blood, as the lungs normally do.

The use of VV-ECMO has become increasingly common with the COVID-19 pandemic.

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Scientists in Belgium described the case of a 64-year-old man who required VV-ECMO due to severe COVID-19. The man had been diagnosed with CAD 10 years earlier and it had responded well to treatment at the time.

The man went to the emergency room after having a cough and shortness of breath for a week. He tested positive for COVID-19 and lab tests showed his oxygen levels were very low so he was urgently intubated and placed on a ventilator. His oxygen levels remained low, however.

“As the patient was only 64 years old, living at home in a satisfactory condition, with previous good responses to treatment of his [CAD], reversible cause of respiratory failure, short term mechanical ventilation (only one hour) and availability of sufficient resources, we considered the patient for ECMO-therapy,” the researchers wrote.

The patient was started on VV-ECMO with precautions taken to avoid aggravating his CAD. For example, he was kept under a heated blanket and fluids infused into his body were warmed beforehand. He also received anti-clotting medicines and red blood cell transfusions during VV-ECMO treatment, which led to a small increase in his oxygen levels, allowing him to be weaned from it without any notable complications.

Anemia persisted, however, and laboratory tests revealed a recurrence of CAD, with high levels of disease-driving cold agglutinin antibodies.

“Although ECMO-run itself was rather uncomplicated, cold agglutinin production continued following the weaning of ECMO,” the researchers wrote. “Cases of COVID-19 infection triggering auto-immune haemolytic anaemia (AIHA) or CAD have been reported.”

The man started treatment with high-dose corticosteroids and rituximab, then plasma exchange, but his hospital stay became complicated by a fungal infection, kidney failure, and intestinal problems that required multiple surgeries. He ended up developing liver failure and died about a month after being hospitalized.

“As most severe complications occurred more than one week after weaning of ECMO, it is difficult to find out if the ECMO-run itself contributed to the disease progression and final outcome in this patient,” the researchers wrote, noting that VV-ECMO nevertheless remains a “feasible” treatment for CAD patients because it was well tolerated in this instance.