부산대학교 도서관

A morbidly obese man who weighed 219 kg was diagnosed with cellulitis of the left lower extremity and coronavirus disease 2019 (COVID-19) pneumonia. After admission, he developed severe respiratory failure. Although his management included intubation and a ventilator, his P/F ratio was 62. He was transferred for the purpose of introducing veno venous (VV) extracorporeal membrane oxygenation (ECMO). A drainage cannula with ultrasound guidance was placed via the right internal jugular vein, and a return cannula was placed via a groin incision right femoral vein. The circuit was de-aired and connected to the ECMO circuit. Esophageal pressure monitoring indicated that the ventilator setting was optimal positive end-expiratory pressure 25 cmH2O. Post-tracheostomy, he was actively rehabilitation on ECMO support. He was weaned off ECMO on day 13 of admission because he tolerated a 24-hour ECMO-off trial without O2 flow to an oxygenator. On day 30 of admission, he was transferred to the referral hospital. Although morbidly obese patients can require substantial additional medical resources and complex management, VV-ECMO is not contraindicated in them, even in patients weighing ＞ 200 kg. It was possible to manage him safely by resolving any associated problems.