Veno-Arterial-Venous Extracorporeal Membrane Oxygenation in a Patient Undergoing Dialysis and Having Cardiopulmonary Failure Due to Coronavirus Disease: A Case Report.

Coronavirus disease (COVID-19), a viral infection caused by severe acute respiratory syndrome coronavirus 2, was first reported in China in December 2019 and has since become a global pandemic. COVID-19 is a multisystem disease with respiratory symptoms as the main presentation. There is growing awareness of the adverse prognostic impact of cardiovascular involvement caused by COVID-19. We report a case of a patient on hemodialysis with COVID-19 who developed cardiopulmonary failure and was successfully weaned off veno-arterial-venous (VAV) extracorporeal membrane oxygenation (ECMO). A 54-year-old man was brought to our intensive care unit (ICU) with respiratory failure due to COVID-19, which had been diagnosed based on antigen testing results. Three days prior, he had started taking dexamethasone orally, but his respiratory distress had worsened two days prior, and he was referred to our hospital. He had a history of hypertension, atrial fibrillation, chronic heart failure, and end-stage renal disease. He was found to have circulatory shock and severe hypoxemia, and computed tomography (CT) showed ground-glass opacities throughout the lung fields. Hypoxemia persisted after ventilation. The ventilation settings for this patient were volume control ventilation, fraction of inspiratory oxygen 100%, tidal volume 360 ml, respiratory rate 22 breaths per minute, and positive end-expiratory pressure 15 mmHg. Therefore, veno-venous ECMO (VV-ECMO) was initiated. Echocardiography showed right ventricular free-wall motion disorder, which was judged to be a complication of cardiogenic shock due to septic cardiomyopathy. The patient was switched to VAV-ECMO, after which his circulatory and respiratory insufficiency gradually improved. He was switched to VV-ECMO on day 7 of hospitalization and weaned off ECMO on day 15 of hospitalization. The patient was fully weaned off the ventilator on day 37 of hospitalization and discharged from the ICU on day 38 of hospitalization. COVID-19 can cause cardiomyopathy, a rare cardiovascular disorder that can lead to cardiogenic shock; however, the cardiac and pulmonary symptoms may not occur simultaneously. Therefore, switching to VAV-ECMO after VV-ECMO was introduced; however, it is important to note that the mortality rate associated with this procedure is high.