Extracorporeal membrane oxygenation for refractory acute respiratory distress syndrome in severe malaria

• Type: Article in International Scientific Journal
• Date: 2013

Authors

Alves, C (Author) Other; Chen, JT (Author) Other; Patel, N (Author) Other; Abrams, D (Author) Other; Figueiredo, P (Author) Other; santos, l (Author) FMUP; Sarmento A (Author) FMUP; Paiva, J-A (Author) FMUP; Bacchetta, M (Author) Other; Wilgus, ML (Author) Other; Roncon-Albuquerque R Jr (Author) FMUP; Brodie, D (Author) Other

Journal

Title: Malaria Journal

Vol. 12

Final page: 306

ISSN: 1475-2875

Publisher: Springer Nature

Indexing

ISI Web of Knowledge - 10 Citations

Scopus - 12 Citations

Other information

Authenticus ID: P-006-83C

DOI: 10.1186/1475-2875-12-306

Abstract (EN): Background: Severe malaria may be complicated by the acute respiratory distress syndrome (ARDS), which is associated with a high mortality. In the present report, a series of three cases of imported malaria complicated by refractory severe ARDS supported with extracorporeal membrane oxygenation (ECMO) is presented. Methods: One female and two male adult patients (ages 39 to 53) were included. Two patients had Plasmodium falciparum infection and one patient had Plasmodium vivax and Plasmodium ovale co-infection. Anti-malarial therapy consisted in intravenous quinine (in two patients) and intravenous quinidine (in one patient), plus clindamycin or doxycycline. Results: Despite lung protective ventilation, a conservative strategy of fluid management, corticosteroids (two patients), prone position (two patients) and inhaled nitric oxide (one patient), refractory severe ARDS supervened (PaO2 to FiO(2) ratio 68) and venovenous ECMO was then initiated. In one patient, a bicaval dual-lumen cannula was inserted; in the two other patients, a two-site configuration was used. Two patients survived to hospital-discharge (duration of ECMO support: 8.5 days) and one patient died from nosocomial sepsis and multi-organ failure after 40 days of ECMO support. Conclusions: ECMO support allowed adequate oxygenation and correction of hypercapnia under lung protective ventilation, therefore reducing ventilator-induced lung injury. ECMO referral should be considered early in malaria complicated by severe ARDS refractory to conventional treatment.

Language: English

Type (Professor's evaluation): Scientific

No. of pages: 7