Management of two circulations in a COVID‐19 patient with secondary superinfection

Optimal oxygenation in the intensive care unit requires adequate pulmonary gas exchange, oxygen‐carrying capacity in the form of hemoglobin, sufficient delivery of oxygenated hemoglobin to the tissue, and an appropriate tissue oxygen demand. In this Case Study in Physiology, we describe a patient with COVID‐19 whose pulmonary gas exchange and oxygen delivery were severely compromised by COVID‐19 pneumonia requiring extracorporeal membrane oxygenation (ECMO) support. His clinical course was complicated by a secondary superinfection with staphylococcus aureus and sepsis. This case study is provided with two goals in mind (1) We outline how basic physiology was used to address life‐threatening consequences of a novel infection—COVID‐19. (2) We describe a strategy of whole‐body cooling to lower the cardiac output and oxygen consumption, use of the shunt equation to optimize flow to the ECMO circuit, and transfusion to improve oxygen‐carrying capacity when ECMO alone failed to provide sufficient oxygenation.