COVID-19 Respiratory Failure: Targeting Inflammation on VV-ECMO Support

The outbreak of novel coronavirus (SARS-CoV-2) which causes the respiratory illness COVID-19 has led to unprecedented efforts at containment due to its rapid community spread, associated mortality, and lack of immunization and treatment. We herein detail a case of a young patient who suffered life-threatening disease and multi-organ failure. His clinical course involved rapid and profound respiratory decompensation such that he required support with veno-venous extracorporeal membrane oxygenation (VV-ECMO). He also demonstrated hyperinflammation (C-reactive protein peak 444.6 mg/L) with severe cytokine elevation (Interleukin-6 peak > 3,000 pg/mL). Through treatment targeting hyperinflammation he recovered from critical COVID-19 respiratory failure and required only 160 hours of VV-ECMO support. He is currently extubated without an oxygen requirement, showing signs of renal recovery on intermittent hemodialysis, and his repeat SARS-CoV-2 test is negative 21 days after his first positive test. We present the first successful case of VV-ECMO support to recovery of COVID-19 respiratory failure in North America.