Successful treatment of out-of-hospital cardiopulmonary arrest due to streptococcal toxic shock syndrome – effectiveness of extracorporeal membrane oxygenation and the rapid antigen group A streptococcus test: a case report

Abstract

BackgroundStreptococcal toxic shock syndrome caused by Streptococcus pyogenes, a group A streptococcus, infection is a rare condition that rapidly progresses to multiple organ failure, shock, and death. It is thus important to promptly establish a diagnosis, provide hemodynamic support, and initiate appropriate antibiotics therapy.Case presentationA 70-year-old Asian man presented with ventricular fibrillation. Extracorporeal membrane oxygenation was initiated 20 minutes after admission after unsuccessful conventional cardiopulmonary resuscitation including five attempts of electrical cardioversion. On the sixth attempt, a sinus rhythm was obtained. A physical examination revealed a large abscess in his right gluteal region, and computed tomography showed a large low-density area in the right gluteus maximus. Blood examination revealed elevated levels of inflammatory markers, hepatic enzymes, creatinine, and creatinine kinase. Transthoracic echocardiography demonstrated diffuse hypokinesis with an ejection fraction of 25%. A subsequent coronary angiography revealed normal findings. Therefore, we diagnosed our patient as having septic shock and conducted surgical drainage. A rapid antigen group A streptococcus test yielded positive results, which necessitated treatment comprising benzylpenicillin and clindamycin. He was successfully weaned from extracorporeal membrane oxygenation and continuous hemodiafiltration 4 days later and ventilation 9 days later; he was later transferred to another hospital to receive a skin graft.ConclusionsOur case report is the first to demonstrate the successful treatment of cardiac arrest caused by streptococcal toxic shock syndrome via extracorporeal membrane oxygenation and prompt initiation of antibiotic therapy. The rapid antigen group A streptococcus test may be an effective approach to promptly diagnose streptococcal toxic shock syndrome caused by group A streptococcus infection.

Venoarterial extracorporeal membrane oxygenation for group B streptococcal toxic shock syndrome: A case report and literature review

“…A total of 7 case reports describing 8 patients [7–13] and 1 retrospective observational study describing 10 patients [15] were identified. In addition, 1 case report was manually searched.…”

Case Report: Therapeutic Strategy With Delayed Debridement for Culture-Negative Invasive Group A Streptococcal Infections Diagnosed by Metagenomic Next-Generation Sequencing

“…Interestingly, mNGS is not the only tool for rapid detection. It was reported that an optical immunoassay technology that could detect the GAS antigen within 5–10 min was available ( 29 ). Another two rapid molecular tests targeting the speB gene of GAS are used experimentally, one of which could get the result in approximately 25 min ( 30 ).…”

A walk through the progression of resuscitation medicine

“…110,111 Despite these challenges, there are many clinical cases in which patients placed on ECMO after CA are able to leave the hospital with full neurological recovery. 112,113 Although not perfect, ECMO provides the potential for life for selected candidates after CA. 108,111,114,115 Beginning in the late part of the last century, many preclinical studies assessed the beneficial effects of cooling the body and the brain after CA.…”