USE OF ANTI-IL-5 (MEPOLIZUMAB) AS RESCUE THERAPY FOR STATUS ASTHMATICUS REQUIRING VENOVENOUS EXTRACORPOREAL MEMBRANE OXYGENATION

TOPIC: Obstructive Lung Diseases TYPE: Medical Student/Resident Case Reports INTRODUCTION: Acute severe asthma exacerbation increases the risk of patients developing respiratory failure and as a result, likelihood them requiring mechanical ventilation goes up. In one study, Afeesa et al. showed actual mortality <10% in medical ICU stay Status Asthmaticus1. CASE PRESENTATION: We describe case 46-year-old morbidly obese female with history persistent admitted to intensive care unit for status asthmaticus. She failed therapy comprising bronchodilators, non-invasive ventilation, parenteral steroids was intubated ventilatory support. Infectious workup at admission including chest imaging bronchoscopy were unrevealing. Bronchoalveolar lavage cell count notable 3% eosinophils. The peripheral blood eosinophil 1400 cells/mm3 serum IgE 163 kU/L. patient initiated on veno-venous ECMO support hypercarbia poor mechanics high airway pressures despite neuromuscular blockade inhaled heliox gas.Keeping view elevated count, given dose subcutaneous IL-5 antagonist monoclonal antibody (Mepolizumab) compassionate off-label use. observed significant improvement counts, sweep gas requirement, peak inspiratory two days after Mepolizumab administration. subsequently taken off from extra-corporeal five biologic DISCUSSION: Patients refractory asthmaticus have no defined guidelines treatments. A combination routine treatments plus adjunct treatment is applied setting ventilation. due sequelae asthmaticus, though rarer, been reported. To our knowledge, this first report use critically ill membrane exacerbation. CONCLUSIONS: Given clinical witnessed patient's condition, rescue can be consideration ECMO. REFERENCE #1: Afessa B, Morales I, Cury JD. Clinical course outcome an Chest. 2001 Nov;120(5):1616-21. DISCLOSURES: No relevant relationships by Ahmed Kiani, source=Web Response Adil Sheikh, Daanish Siddique,