Acute asthma exacerbations can be severe and life-threatening. In some cases, standard interventions and management do not result in reversal of bronchoconstriction. It is crucial to detect patients with impending respiratory failure and escalate management to invasive mechanical ventilatory support and, in refractory cases, interventions like extracorporeal membrane oxygenation (ECMO). This technique is not frequently utilized but has proven to be effective in settings of resistant status asthmaticus.

We describe a case of respiratory distress secondary to asthma exacerbation, which rapidly devolved into status asthmaticus. It was resistant to all standard and off-label management modalities, which necessitated the use of veno-venous extracorporeal CO2 removal (VVECCO2R). ECMO was utilized in our case with great success. In this article, we aim to raise awareness of the importance of VVECCO2R in the treatment of refractory status asthmaticus and the difficulties that prevent widespread implementation of the technique across healthcare facilities.