A Case of COVID-19 Pneumonia Leading to Acute Respiratory Distress Syndrome (ARDS) and Multi-organ Failure Requiring Extracorporeal Membrane Oxygenation (ECMO) for Six Months and an Associated Critical Limb Ischemia

Kulsoom Durrani; Faiza Butt; Syed Atif; Erum Azhar; Abdul Waheed

doi:10.7759/cureus.57329

A Case of COVID-19 Pneumonia Leading to Acute Respiratory Distress Syndrome (ARDS) and Multi-organ Failure Requiring Extracorporeal Membrane Oxygenation (ECMO) for Six Months and an Associated Critical Limb Ischemia

Cureus. 2024 Mar 31;16(3):e57329. doi: 10.7759/cureus.57329. eCollection 2024 Mar.

Authors

Kulsoom Durrani¹, Faiza Butt², Syed Atif², Erum Azhar^{3

4}, Abdul Waheed^{5

6}

Affiliations

¹ College of Medicine, Penn State University, Hershey, USA.
² Family Medicine Residency Program, WellSpan Good Samaritan Hospital, Lebanon, USA.
³ Obstetrics and Gynecology, Creighton University School of Medicine, Phoenix, USA.
⁴ Obstetrics and Gynecology, Dignity Health East Valley, Gilbert, USA.
⁵ Family and Community Medicine, Creighton University School of Medicine, Phoenix, USA.
⁶ Family Medicine, Dignity Health Medical Group, Gilbert, USA.

Abstract

This article presents the case of a 57-year-old woman with a history of rheumatoid arthritis who developed severe coronavirus disease 2019 (COVID-19) pneumonia that progressed to acute respiratory distress syndrome (ARDS) and multi-system organ failure. Despite initial slow progression and multiple hospital readmissions, her condition rapidly deteriorated, leading to full respiratory failure requiring intubation and ventilation. She was transferred to a specialized center where she underwent extracorporeal membrane oxygenation (ECMO) and hemodialysis for acute renal failure. Unfortunately, she remained dependent on ECMO for an extended period of six months. Although she made a gradual recovery, the prolonged critical care treatment resulted in critical ischemia of multiple extremities, necessitating a below-knee amputation (BKA) of her left lower extremity and transmetatarsal amputations of her right hand. This case reports one of the longest ECMO treatments for COVID-19 and associated comorbidities in the literature. Clinicians could include a longer duration of treatment and potential associated disabilities in the informed consent.

Keywords: acute respiratory distress syndrome (ards); complication of treatment; coronavirus disease (covid-19); limb ischemia; vv ecmo.

Publication types

Case Reports