임신 중 중증 천식지속상태 환자에서 체외막산소화장치 적용 1예 = Utilization of extracorporeal membrane oxygenation for refractory status asthmaticus during pregnancy: A case report

다국어 초록 (Multilingual Abstract)

Refractory status asthmaticus represents the most severe clinical presentations of asthma, and it is typically associated with the presence of hypoxemia, hypercapnia, lactic acidosis, dynamic hyperventilation and altered state of consciousness. Several case reports have demonstrated extracorporeal membrane oxygenation (ECMO) as an alternative treatment method for patients with status asthmaticus that failed to respond to maximal conventional therapy. We experienced a case of pregnant woman with severe asthma attack not relieved by conventional treatment, in whom early administration of ECMO resulted in a good outcome. A 23-year-old woman at, 11 weeks of pregnancy, was admitted with acute asthma attack. Despite maximal rescue therapies with mechanical ventilation, her condition gradually deteriorated. Venovenous ECMO was initiated 4 hours from intubation and gas exchange with lung mechanics was rapidly recovered within hours. She was extubated 45 hours after initiation of ECMO and had successful weaning from ECMO 2 days after extubation. The patient had no complication and gave birth to a healthy baby at 37 weeks of gestation. This is the first case report in Korea on the successful use of ECMO in a pregnant woman with severe respiratory insufficiency due to status asthmaticus, who failed to respond to mechanical ventilation and maximum pharmacological treatment. Early ECMO application is a useful treatment option for patients with refractory status asthmaticus refractory to conventional therapy.

참고문헌 (Reference)

1 Steinack C, "The use of life-saving extracorporeal membrane oxygenation(ECMO)for pregnant woman with status asthmaticus" 54 : 84-88, 2017

2 Clifford C, "Successful use of extracorporeal membrane oxygenation for status asthmaticus in a woman with a periviable pregnancy" 132 : 1007-1010, 2018

3 Mikkelsen ME, "Outcomes using extracorporeal life support for adult respiratory failure due to status asthmaticus" 55 : 47-52, 2009

4 Restrepo RD, "Near-fatal asthma : recognition and management" 14 : 13-23, 2008

5 Serrano-Pariente J, "Near-fatal asthma : a heterogeneous clinical entity" 17 : 28-35, 2017

6 Levy BD, "Medical and ventilatory management of status asthmaticus" 24 : 105-117, 1998

7 Oddo M, "Management of mechanical ventilation in acute severe asthma : practical aspects" 32 : 501-510, 2006

8 Lee CH, "Healthcare utilisation by pregnant patients with asthma in South Korea : a cohort study using nationwide claims data" 5 : e008416-, 2015

9 Plaza V, "Frequency and clinical characteristics of rapid-onset fatal and near-fatal asthma" 19 : 846-852, 2002

10 MacDonnell KF, "Extracorporeal membrane oxygenator support in a case of severe status asthmaticus" 31 : 171-175, 1981

11 Di Lascio G, "Extracorporeal membrane oxygenation support for life-threatening acute severe status asthmaticus" 32 : 157-163, 2017

12 Yeo HJ, "Extracorporeal membrane oxygenation for life-threatening asthma refractory to mechanical ventilation : analysis of the Extracorporeal Life Support Organization registry" 21 : 297-, 2017

13 Moore SA, "Extracorporeal life support during pregnancy" 151 : 1154-1160, 2016

14 "ELSO guidelines for cardiopulmonary extracorporeal life support" Extracorporeal Life Support Organization

15 Allyn J, "Complication patterns in patients undergoing venoarterial extracorporeal membrane oxygenation in intensive care unit : multiple correspondence analysis and hierarchical ascendant classification" 13 : e0203643-, 2018

16 Murphy VE, "Asthma in pregnancy" 32 : 93-110, 2011

17 Stenius-Aarniala B, "Asthma and pregnancy : a prospective study of 198 pregnancies" 43 : 12-18, 1988

18 Macmullen NJ, "Adverse maternal outcomes in women with asthma versus women without asthma" 23 : e9-e13, 2010