RESUMEN
This clinical case shows a patient who was admitted to the Hospital Regional Antofagasta (HRA) due to pneumonia associated with COVID-19, coinfected with Mycobacterium tuberculosis, and who consequently developed Acute Respiratory Distress Syndrome (ARDS) in a Catastrophic condition, which warranted Sequential management that began with airway rescue at the hospital of origin (Barros Luco Trudeau (HBLT)) with mechanical ventilation support, in prone condition with poor results. Upon arrival of the transfer team, Extracorporeal Membrane Cannulation (ECMO) was decided. After his favorable response, he was weaned to the artificial respirator (RA) and supported with Arteriovenous CO2 remover (NovalungR ), a maneuver that lasted 192 hours, achieving improvement from Mechanical Ventilation support, until his final weaning. This is an unprecedented clinical case, due to the combination of catastrophic ARDS, associated with the COVID 19 and TB coinfection, and for this reason it is necessary to document cases, guide behaviors and management, which can be adapted according to the technological and professional development with which count each hospital.