Successful VV-ECMO weaning facilitated by addition of sodium bicarbonate to the dialysate in a COVID-19 patient with severe metabolic acidosis

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Other Title
  • 重度代謝性アシドーシスに対する透析液内への重炭酸ナトリウム添加でVV-ECMO離脱に成功したCOVID-19の一例
  • ジュウド タイシャセイ アシドーシス ニ タイスル トウセキエキ ナイ エ ノ ジュウ タンサン ナトリウム テンカ デ VV-ECMO リダツ ニ セイコウ シタ COVID-19 ノ イチレイ
Published
2023-06-01
DOI
  • 10.34325/jsbpcc.14.1_17
Publisher
Japan Society for Blood Purification in Critical Care

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<p>Case: A man in his 60s with COVID-19 required mechanical ventilation on day 8 of the illness. On day 12, the P/F ratio reached 120, and veno-venous ECMO （VV-ECMO） was started. His creatinine level increased to 1.45 mg/dL, and high-volume continuous hemofiltration was initiated. On day 19, he developed severe diarrhea, with losses exceeding 2,000 g/day, and metabolic acidosis (pH 7.19). The renal failure worsened (creatinine 1.78 mg/dL). It was difficult to maintain pH when PaCO2 exceeded 50 mmHg. NaHCO3 (bicarbonate 35 mEq/L) was added to the replenisher to raise the bicarbonate level to 40 mEq/L, and continuous renal replacement therapy was initiated. The bicarbonate level increased to 27 mEq/L and pH improved to 7.34. However, NaHCO3 supplementation was discontinued owing to an increased serum sodium level, and metabolic acidosis worsened. Therefore, the same dosage was reinitiated to maintain the pH, and weaning from VV-ECMO was started. VV-ECMO was stopped on day 41. Conclusion: Addition of NaHCO3 to the dialysate to facilitate prolonged VV-ECMO withdrawal in severe metabolic acidosis can be performed safely. It does not require intravenous access and the risk of infection is lower than with conventional intravenous infusion. </p>

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