{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T19:50:50Z","timestamp":1784749850303,"version":"3.55.0"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,4,29]],"date-time":"2025-04-29T00:00:00Z","timestamp":1745884800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>The indications for extracorporeal membrane oxygenation (ECMO) are becoming increasingly widespread nowadays. This case report describes the unique presentation of an adult patient with a combination of two rare complications: life-threatening angioedema caused by angiotensin-converting enzyme inhibitors (ACEi) and subsequent post-obstructive negative pressure pulmonary edema (NPPE). In this case, worsening angioedema that was unresponsive to medication led to severe airway obstruction and near-fatal acute respiratory syndrome due to NPPE. The worsening clinical course required a multidisciplinary approach and immediate initiation of extracorporeal membrane oxygenation (VV-ECMO). The literature reports that most NPPE cases resolve with oxygenation. However, in our case, the NPPE was refractory to mechanical ventilatory support, and we had to initiate VV-ECMO to prevent the patient from going into cardiac arrest due to severe hypoxia. This case underscores the critical role of VV-ECMO as a bridge to recovery from severe NPPE. It also highlights the need to raise clinicians\u2019 awareness of the potential life-threatening side effects of the commonly used antihypertensive drug perindopril.<\/jats:p>","DOI":"10.3389\/fmed.2025.1483405","type":"journal-article","created":{"date-parts":[[2025,4,29]],"date-time":"2025-04-29T04:10:35Z","timestamp":1745899835000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Case Report: VV-ECMO as a bridge to recovery from ACE inhibitor induced post-obstructive negative pressure pulmonary edema"],"prefix":"10.3389","volume":"12","author":[{"given":"Darja","family":"Smirnova","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Steina","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mara","family":"Klibus","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edgars","family":"Prozorovskis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Strike","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olegs","family":"Sabelnikovs","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,4,29]]},"reference":[{"key":"ref1","volume-title":"Guidelines for the pharmacological treatment of hypertension in adults","year":"2021"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1874","DOI":"10.1097\/HJH.0000000000003480","article-title":"2023 ESH guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Hypertension: endorsed by the International Society of Hypertension (ISH) and the European renal association (ERA)","volume":"41","author":"Mancia","year":"2023","journal-title":"J Hypertens"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"257","DOI":"10.1038\/s41440-023-01491-9","article-title":"Prediction and prevention of ACE-inhibitor-induced angioedema\u2014an unmet clinical need in management of hypertension","volume":"47","author":"Rubin","year":"2024","journal-title":"Hypertens Res"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"106081","DOI":"10.1016\/j.intimp.2019.106081","article-title":"ACE inhibitor-mediated angioedema","volume":"78","author":"Montinaro","year":"2020","journal-title":"Int Immunopharmacol"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1016\/j.emc.2021.09.004","article-title":"Angiotensin-converting enzyme inhibitor\u2013induced angioedema","volume":"40","author":"Wilkerson","year":"2022","journal-title":"Emerg. 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