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Background <p>Drowning can lead to acute respiratory distress syndrome (ARDS), which is associated with high mortality and poses substantial clinical management challenges. Ultra-protective ventilation strategy combined with veno-venous extracorporeal membrane oxygenation (VV-ECMO) present a viable alternative, yet evidence supporting these strategies in drowning-related ARDS patients remains scarce.</p> Case presentation <p>This case report describes an 18-year-old female who experienced cardiac arrest following near-drowning. After the return of spontaneous circulation, the patient developed severe pulmonary edema leading to ARDS. VV-ECMO was initiated, resulting in a significant improvement in the Horowitz coefficient. Using a combination of VV-ECMO and an ultra-protective ventilation strategy with a lowest tidal volume of 2.8&#xa0;ml/kg (predicted body weight, PBW), the patient’s lung condition improved significantly. Static lung compliance rose from 11&#xa0;ml/cm H₂O to 46&#xa0;ml/cm H₂O. The patient was successfully weaned from VV-ECMO on Day 15, extubated on Day 27, and eventually discharged with no obvious pulmonary sequelae.</p> Conclusion <p>The present case indicate that combining ultra-protective ventilation and VV-ECMO may be an effective approach for managing severe near-drowning-related ARDS by improving lung function and increasing the likelihood of successful extubation. This strategy minimizes ventilator-induced lung injury (VILI) while optimizing oxygenation, providing a new perspective for treating similar patients. Further studies are needed to validate its efficacy and optimize treatment protocols.</p>

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Rescue strategies combining ultra-protective ventilation and veno-venous ECMO in a patient with near-drowning-related severe ARDS: a case report and literature review

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月8日

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  • Li Zhang,
  • Zhekang Peng,
  • Dingdeng Wang,
  • Fei Tian,
  • Xingguang Qu,
  • Zhaohui Zhang,
  • Gaosheng Zhou

摘要

Background

Drowning can lead to acute respiratory distress syndrome (ARDS), which is associated with high mortality and poses substantial clinical management challenges. Ultra-protective ventilation strategy combined with veno-venous extracorporeal membrane oxygenation (VV-ECMO) present a viable alternative, yet evidence supporting these strategies in drowning-related ARDS patients remains scarce.

Case presentation

This case report describes an 18-year-old female who experienced cardiac arrest following near-drowning. After the return of spontaneous circulation, the patient developed severe pulmonary edema leading to ARDS. VV-ECMO was initiated, resulting in a significant improvement in the Horowitz coefficient. Using a combination of VV-ECMO and an ultra-protective ventilation strategy with a lowest tidal volume of 2.8 ml/kg (predicted body weight, PBW), the patient’s lung condition improved significantly. Static lung compliance rose from 11 ml/cm H₂O to 46 ml/cm H₂O. The patient was successfully weaned from VV-ECMO on Day 15, extubated on Day 27, and eventually discharged with no obvious pulmonary sequelae.

Conclusion

The present case indicate that combining ultra-protective ventilation and VV-ECMO may be an effective approach for managing severe near-drowning-related ARDS by improving lung function and increasing the likelihood of successful extubation. This strategy minimizes ventilator-induced lung injury (VILI) while optimizing oxygenation, providing a new perspective for treating similar patients. Further studies are needed to validate its efficacy and optimize treatment protocols.