The Challenges of Management of Jehovah's Witness with Covid-19 Supported by Veno-Venous Ecmo: A Case Report and Literature Review

Severe Acute Respiratory Syndrome (ARDS) is a common cause of intensive care unit (ICU) admissions and is associated with high mortality. A significant proportion of patients with severe acute respiratory syndrome-corona virus-2 (SARS-CoV2), aka, coronavirus disease-2019 (COVID-19) developed ARDS and required invasive mechanical ventilation. Extracorporeal membrane oxygenation (ECMO) has been used in patients with severe ARDS secondary to COVID-19 with comparable success rate to non-COVID-19 etiology. The majority of Jehovah’s Witness (JW) group hold the belief that transfusion of blood or blood products is prohibited which present the clinical team with several clinical challenges and ethical dilemmas. Here, we present a case of JW with severe COVID-19 infection, multiple organ failure and ARDS who was placed on ECMO for 20 days and cared for in the ICU for further 20 days prior to transfer to rehabilitation. We discuss the challenges of management, ethical considerations and provide suggestions for the management of such patients.