LỌC CO2 QUA MÀNG NGOÀI CƠ THỂ VÀ OMALIZUMAB ĐIỀU TRỊ CƠN HEN PHẾ QUẢN ÁC TÍNH KHÁNG TRỊ, BÁO CÁO CA BỆNH

Abstract

This case report describes the combined use of extracorporeal CO₂ removal (ECCO₂R) and omalizumab for the management of refractory status asthmaticus (RSA) in a patient with high-IgE allergic asthma phenotype. A 54-year-old male with a history of allergic asthma and multiple prior admissions to the respiratory medicine ward presented to the ICU for the first time at 18:38 on November 24, 2025, and was immediately placed on high-flow nasal cannula (HFNC). ECCO₂R was initiated using a PrismaLung membrane on the PrisMax platform, rapidly correcting acid-base disturbances, controlling dynamic hyperinflation, and reducing ventilatory pressures, allowing temporary control of severe hypercapnia while ECMO candidacy was being considered. Concurrent with RSA, the patient exhibited persistent generalized urticaria unresponsive to intravenous adrenaline, suggesting a severe allergic asthma phenotype with markedly elevated total IgE (907 IU/mL), prompting the simultaneous initiation of ECCO₂R and subcutaneous omalizumab 600 mg. The patient was successfully extubated at 9:40 AM on December 4, 2025 (after 8.5 days of mechanical ventilation) and subsequently transferred to the respiratory medicine ward. This case illustrates that ECCO₂R combined with omalizumab represents a potentially feasible rescue strategy in RSA, leveraging the mechanistic complementarity between extracorporeal physiological support and targeted immunologic therapy.