Extracorporeal membrane oxygenation support for four patients with acquired immunodeficiency syndrome complicated by pneumocystis pneumonia: a case series and literature review

Y N Sun, Jingjing Hao, Yufeng Liu, Xiaoxi Zhong, Xueqing Wang, Lin Pu, Liu Jl

Background Acquired immunodeficiency syndrome (AIDS) complicated by Pneumocystis pneumonia (PCP) is characterized by an insidious onset, rapid progression, and a critical clinical course. Severe complications, such as respiratory failure and pneumothorax, may occur in the absence of timely and effective intervention, resulting in increased mortality. Extracorporeal membrane oxygenation (ECMO) can serve as a salvage therapy by temporarily and effectively replacing cardiopulmonary function. Objective We aimed to summarize the clinical experience of veno-venous extracorporeal membrane oxygenation (V-V ECMO) support in four patients with AIDS complicated by PCP. Methods Clinical data from four patients with AIDS who were complicated by PCP and received ECMO support at Beijing Ditan Hospital, Capital Medical University, were retrospectively analyzed. The timing of ECMO initiation, mode selection, mechanical ventilation (MV) management, sedation and analgesia strategies, prognosis, and clinical experience were evaluated, and treatment experience was summarized. Results All four patients were definitively diagnosed with AIDS complicated by PCP and respiratory failure. All patients received ventilatory support and developed barotrauma. Pneumothorax occurred in cases 1, 2, and 4, whereas pneumomediastinum was detected in case 3. All patients received V-V ECMO support, which improved clinical conditions in all cases. Finally, cases 1 and 2 died, whereas cases 3 and 4 recovered and were discharged. Among them, awake ECMO was successfully implemented in case 3. Conclusion For patients with AIDS complicated by PCP, particularly for those with concomitant barotrauma, early initiation of ECMO support may rapidly improve systemic oxygenation and lower the intensity of MV. This approach may decrease ventilator-induced lung injury (VILI), facilitate lung rest and lung protection, and provide a therapeutic window for treating the underlying disease. Clinicians should comprehensively evaluate disease reversibility, immune recovery potential, and the severity of lung injury. Withholding ECMO therapy solely due to HIV infection status should be avoided.