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

Carlos Alves, Jen Ting Chen, Nina Patel, Darryl Abrams, Paulo Figueiredo, Lurdes Santos, António Sarmento, José Artur Paiva, Matthew Bacchetta, May Lin Wilgus, Roberto Roncon-Albuquerque, Daniel Brodie

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Abstract

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 (PaO§ssub§2§esub§ to FiO§ssub§2§esub§ 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.

Original languageEnglish (US)
Article number306
JournalMalaria Journal
Volume12
Issue number1
DOIs
StatePublished - Sep 3 2013
Externally publishedYes

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Keywords

  • Acute respiratory distress syndrome
  • Extracorporeal membrane oxygenation
  • Malaria
  • Plasmodium falciparum

ASJC Scopus subject areas

  • Parasitology
  • Infectious Diseases

Cite this

Alves, C., Chen, J. T., Patel, N., Abrams, D., Figueiredo, P., Santos, L., Sarmento, A., Paiva, J. A., Bacchetta, M., Wilgus, M. L., Roncon-Albuquerque, R., & Brodie, D. (2013). Extracorporeal membrane oxygenation for refractory acute respiratory distress syndrome in severe malaria. Malaria Journal, 12(1), [306]. https://doi.org/10.1186/1475-2875-12-306