Use of two parallel oxygenators during veno-venous extracorporeal membrane oxygenation in a patient with severe obesity and COVID-19 pneumonia.

Background: Veno-Venous Extracorporeal Membrane Oxygenation (VV-ECMO) is one effective treatment for COVID-19 pneumonia, but controversy regarding VV-ECMO management in obese patients still exists. In this report, we described a case in which two oxygenators were used in parallel in a severely obese patient (Body mass index: 60 kg/m 2 , body surface area: 2.8 m 2 ). Case: The case was of a 27-year-old man diagnosed with COVID-19 pneumonia and admitted to our hospital. VV-ECMO was required on the fifth day after admission due to gradually worsening respiratory conditions and partial pressure of arterial oxygen (PaO 2 )/FiO 2 ratio of 77. Immediately after the initiation of VV-ECMO, post-oxygenator in circuit, PaO 2 was low at 134 mmHg. Even though the VV-ECMO circuit was replaced on the same day, the PaO 2 still was low at 261 mmHg. Thus, we decided to use two oxygenators in parallel, after which the PaO 2 stabilized at 400-500 mmHg. Conclusions: In this case, VV-ECMO oxygenation could be stabilized by utilizing two oxygenators in parallel. Using two membrane oxygenators may be a treatment option in severely obese patients with respiratory failure.