Refractory Acute Respiratory Distress Syndrome Supported by Extracorporeal Membrane Oxygenation due to Leptospirosis at Réunion Island and a Literature Review.

Leptospirosis is a zoonosis prevalent on Réunion Island. Severe forms with acute respiratory failure can lead to refractory hypoxemia, requiring the use of extracorporeal membrane oxygenation (ECMO). The aim for the present study was to describe all cases of leptospirosis complicated by refractory acute respiratory distress syndrome (ARDS) requiring veno-venous ECMO on Réunion Island and to conduct a literature review. This retrospective observational study was conducted in a multidisciplinary intensive care unit of the University Hospital of Réunion Island. The aim was to describe the clinical, biological, and prognostic characteristics of patients who developed leptospirosis complicated by refractory ARDS requiring ECMO between January 2011 and December 2024. A total of 14 patients with a median age of 38 years and few comorbidities were included. The organ failure most commonly associated with respiratory involvement was acute kidney injury (93%). The median delay between mechanical ventilation and ECMO support was 0 (0-1) days. The median duration of ECMO support was short (7 [4-12] days). The mortality rate in this population was 29%. A systematic literature review revealed 50 cases of patients with leptospirosis requiring ECMO, with a median age of 34 years and a mortality rate of 20%. The favorable prognosis of patients with refractory ARDS due to leptospirosis justifies the use of ECMO. Early referral to a center equipped with ECMO is essential, given the rapid decline in respiratory function.