(591) Prolonged V.v.-Ecmo for Covid-19 Ards with Lung Recovery

INTRODUCTION: There is limited data regarding prolonged use of veno-venous extracorporeal membrane oxygenation (V.V.-ECMO) for novel coronavirus disease 2019 (COVID-19) with the expectations of lung recovery or when to transition goals and consider lung transplant. We present a patient with lung recovery after an eight-month ECMO course for COVID-19. CASE REPORT: In January 2022 a 33-year-old obese (BMI 43), unvaccinated, Hispanic man presented to the emergency department positive for COVID-19 with profound hypoxia requiring intubation. After failing maximum medical therapy, he was cannulated on V.V.-ECMO with a right internal jugular 31Fr single-access, dual-stage right atrium-to-pulmonary artery cannula. Sedation was weaned and he was extubated to ECMO support. Mobilization was initiated immediately with the use of a vertical mobilization bed and progressed to ambulating on ECMO. He demonstrated persistent bilateral airspace disease with complete opacification of both lung fields for several months. With ongoing ECMO support his lung function improved. He was decannulated following eight months of support to nasal cannula and discharged home. He continues to improve at home and is able to engage in all activities of daily living. SUMMARY: We demonstrate lung recovery following COVID 19 infection with severe ARDS after prolonged ECMO support. Liberating the patient from the ventilator, weaning sedation, physical therapy and patience resulted in pulmonary recovery. Prolonged ECMO support was required to achieve lung recovery in this patient.