Abstract Introduction Status asthmaticus (SA) is a severe, life-threatening form of asthma exacerbation characterized by progressive airflow obstruction and respiratory failure unresponsive to standard therapy. In such cases, refractory hypercapnia and dynamic hyperinflation can result in life-threatening ventilatory failure despite optimized mechanical ventilation. Extracorporeal membrane oxygenation (ECMO), specifically veno-venous (VV) ECMO, serves as a salvage therapy that allows for extracorporeal gas exchange, reduction of ventilator-induced lung injury, and time for airway inflammation to subside. We present a case of a young postpartum female with severe status asthmaticus who failed conventional management and was successfully managed with VV ECMO. Case Presentation A 32-year-old woman, one week postpartum, with a known history of asthma, presented to an outside hospital in acute respiratory distress. Arterial blood gas revealed severe hypercapnic respiratory failure. She was intubated and treated with intravenous methylprednisone, magnesium sulfate, and combination bronchodilators (ipratropium bromide-albuterol sulfate) with minimal improvement. She was subsequently transferred to our facility for further management of refractory respiratory failure.Upon arrival, ventilator adjustments were made, including reduction in respiratory rate, increase in inspiratory flow rate, and prolonged expiratory time to mitigate dynamic hyperinflation and air trapping. Despite these interventions, the patient continued to exhibit severe bronchospasm, elevated peak pressures, and worsening acidosis despite deep sedation and paralysis. Given her refractory hypercapnia, hemodynamic instability, and poor air movement, a multidisciplinary decision was made to initiate VV ECMO for effective CO2 removal and lung rest. During ECMO, the patient underwent multiple bronchoscopies to relieve mucus plugging that caused right upper lobe collapse. Bronchoalveolar lavage and respiratory cultures grew Pseudomonas aeruginosa, which was treated with Cefepime. She developed paroxysmal supraventricular tachycardia during ECMO, which was successfully managed with amiodarone and diltiazem infusions. She showed steady improvement, was decannulated on day 12, and extubated on day 13 after a successful spontaneous breathing trial. Corticosteroids were tapered, and she was discharged to inpatient rehabilitation on Symbicort and Spiriva with close pulmonology follow-up. Discussion This case highlights the role of early VV ECMO as a lifesaving bridge in refractory status asthmaticus when conventional ventilation fails to correct hypercapnia. ECMO enables controlled ventilation, minimizes barotrauma, and provides time for airway inflammation to resolve. Early recognition of ventilatory failure and coordinated multidisciplinary management are essential to optimize outcomes in these critically ill patients. This abstract is funded by: None
Joseph et al. (Fri,) studied this question.