Awake Extracorporeal Membrane Oxygenation in Coronavirus Disease 2019 Patients Without Invasive Mechanical Ventilation

OBJECTIVES/BACKGROUND: Extracorporeal membrane oxygenation is used as rescue therapy for patients with acute respiratory distress syndrome in whom conventional therapy has failed prior to an Extra Corporeal Membrane Oxygenator to rescue Lung Injury in Severe Acute Respiratory Distress Syndrome trial. Since then, extracorporeal membrane oxygenation has been incorporated as part of the standard treatment algorithm in many centers for patients with severe acute respiratory distress syndrome. Since the emergence of coronavirus disease 2019 in early 2020, extracorporeal membrane oxygenation has been used effectively as rescue therapy and as a bridge to recovery in some patients with refractory respiratory failure. DESIGN, SUBJECT, AND INTERVENTION: We present a 38-year-old male healthcare worker diagnosed with coronavirus disease 2019 and progressed to critical condition with severe surgical emphysema on a high-flow nasal cannula with Fio2 100%, a flow of 40 L/min, and a maximum oxygen saturation of 88%. He was successfully treated by applying awake extracorporeal membrane oxygenation, without a need for invasive mechanical ventilation, to avoid worsening barotrauma and hemodynamic compromise potentially induced by positive pressure ventilation. MAIN RESULTS AND CONCLUSIONS: To our knowledge, this is one of the first cases to be reported in the literature on the use of awake extracorporeal membrane oxygenation as a “treatment” for barotrauma due to severe acute respiratory distress syndrome in a coronavirus disease 2019 patient, without the need for invasive mechanical ventilation. In selected patients with severe respiratory failure, awake extracorporeal membrane oxygenation can be used as a salvage treatment and obviate the need for invasive mechanical ventilation.