# A Case of COVID-19 Pneumonia Leading to Acute Respiratory Distress Syndrome (ARDS) and Multi-organ Failure Requiring Extracorporeal Membrane Oxygenation (ECMO) for Six Months and an Associated Critical Limb Ischemia

## TL;DR

A 57-year-old woman with rheumatoid arthritis developed severe complications from COVID-19, requiring six months of ECMO and resulting in limb amputations.

## Contribution

This case highlights one of the longest ECMO treatments for severe COVID-19 and its associated long-term physical disabilities.

## Key findings

- The patient required six months of ECMO due to severe ARDS and multi-organ failure from COVID-19.
- Prolonged critical care led to critical limb ischemia and multiple amputations.
- The case emphasizes the need to consider long-term treatment and potential disabilities in informed consent for severe COVID-19 patients.

## Abstract

This article presents the case of a 57-year-old woman with a history of rheumatoid arthritis who developed severe coronavirus disease 2019 (COVID-19) pneumonia that progressed to acute respiratory distress syndrome (ARDS) and multi-system organ failure. Despite initial slow progression and multiple hospital readmissions, her condition rapidly deteriorated, leading to full respiratory failure requiring intubation and ventilation. She was transferred to a specialized center where she underwent extracorporeal membrane oxygenation (ECMO) and hemodialysis for acute renal failure. Unfortunately, she remained dependent on ECMO for an extended period of six months. Although she made a gradual recovery, the prolonged critical care treatment resulted in critical ischemia of multiple extremities, necessitating a below-knee amputation (BKA) of her left lower extremity and transmetatarsal amputations of her right hand. This case reports one of the longest ECMO treatments for COVID-19 and associated comorbidities in the literature. Clinicians could include a longer duration of treatment and potential associated disabilities in the informed consent.