Extracorporeal Membrane Oxygenation: An Efficient Approach To Treat Acute Respiratory Distress Syndrome After Inhalation Of Zinc Chloride From Smoke Bomb: A Case Report

Acute respiratory distress syndrome (ARDS) induced by inhalation of zinc chloride remains refractory to common treatment. No standard protocols exist for treating it due to its rare occurrence. This case report discusses three soldiers who were exposed to a smoke bomb in an enclosed space for nearly 3 minutes. As no protective equipment was used, the soldiers rapidly developed ARDS and were subsequently complicated by pneumothorax and pneumomediastinum. A combination of comprehensive therapies was used for initial treatment, which included a protective lung ventilation strategy, bilateral tube thoracotomy, prone position ventilation, corticoids, etc. As adequate oxygenation could not be achieved, we decided to initiate extracorporeal membrane oxygenation (ECMO) for them. Oxygenation showed gradual improvement in their health conditions. Arterial blood gas analysis revealed increased PO2 and decreased PCO2, indicating an improvement in the ventilatory and gas exchange functions. ECMO support was provided for 17 and 21 days respectively, where two patients achieved satisfactory oxygenation and ECMO was discontinued. Both survived were discharged from the hospital after approximately 70 days. The other patient, whose condition was more severe, died of pneumorrhagia on day 3 of post-accident despite receiving the same treatment approach as the surviving patients. These case studies indicate that ECMO may be a successful treatment option for patients with severe ARDS experiencing similar disease process/progression.