A 40 year old male was admitted to intensive care unit requiring intubation and ventilation for community acquired pneumonia. He developed acute respiratory distress syndrome (ARDS) and on day 2 commenced an atracurium infusion for worsening hypoxaemia.
Despite two sessions of prone ventilation he failed to improve and required high ventilatory pressures. On day 5 he was placed on venovenous extracorporeal membrane oxygenation. (VV ECMO).
Bifemoral cannulae (25F access cannula and 23F return cannula) were inserted. Standard heparin anticoagulation was commenced. After an initial period of stability he became hypoxaemic (arterial oxygen saturations 82%) despite 5.2L extracorporeal blood flow and 6L sweep gas flow.
