Extracorporeal Membrane Oxygenation for Life-Threatening Status Asthmaticus Refractory to Conventional Mechanical Ventilation - A Case Report and Literature Review

體外膜氧合（ECMO）使用於傳統呼吸器治療失敗之嚴重氣喘惡化：病例報告與文獻回顧

陳祐易(You-Yi Chen) ； 姚宗漢(Zong-Han Yao)

《胸腔醫學》 34卷6期 (2019/12) Pp. 240-245

摘要

Despite continuous improvements in asthma treatment, severe asthma exacerbation requiring hospitalization or/and critical care remains a crucial healthcare issue. Status asthmaticus is a life-threatening condition caused by acute respiratory failure and is the most severe clinical presentation of asthma. It is generally characterized by cardiovascular dysfunction and hypercapnia with severe acidemia that requires invasive medication treatment and mechanical ventilation. Nonconventional interventions such as general anesthesia, heliox, bronchoscopic retrieval of mucous plugs and extracorporeal life support also have been advocated for patients with fulminant asthma. Immediate mortality rate of those patients who are mechanically ventilated for acute severe asthma is very low; however, mortality is often associated with out-of-hospital cardiac arrest before intubation. Patients who have been intubated for severe asthma are at an increased risk of death if conventional management fails to relieve dynamic hyperinflation and progressive hypercapnia. We report the case of a female suffering from life-threatening asthma. She presented with severe hypercapnia and life-threatening acidemia, and failed to respond to conventional therapy and mechanical ventilation. Under the circumstances, early and emergency administration of extracorporeal membrane oxygenation (ECMO) led to a dramatic improvement in lung mechanics and gas exchange. As an effective rescue therapy, ECMO plays a crucial role in the management of life-threatening asthma when conventional therapy fails.

關鍵字

extracorporeal membrane oxygenation (ECMO) ； asthma

並列摘要

氣喘目前已具有效的治療方式，但氣喘急性發作可能發生在接受治療中的病人且可能為嚴重甚至致命的疾病。本文提出的案例報告是一位沒有規律使用氣喘控制藥物之70歲女性，主訴為急性發作之呼吸困難與意識狀態變化30分鐘，經急性氣喘惡化之藥物處置與機械式呼吸器輔助治療下仍持續惡化至致命性心律不整，藉由體外膜氧合（ECMO）的治療成功避免嚴重併發症，且於一周的加護病房治療後成功脫離呼吸器與ECMO。目前在急性氣喘惡化使用體外心肺支持系統（ECLS）治療尚無明確的治療指引，但藉由此個案報告與文獻回顧，在嚴重氣喘惡化病人及早使用體外心肺支持系統確實能提供此類病人更好的治療預後。

並列關鍵字

體外膜氧合（ECMO） ； 氣喘