Successful use of extracorporeal membrane oxygenation support in severe septic shock with associated acute cardiomyopathy

Abstract

A 24-year-old female presented with sepsis and cardiogenic shock 4 days after vaginal delivery. Veno-arterial extracorporeal membrane oxygenation (VA ECMO) therapy was used for cardiovascular support as a bridge for recovery. The use of VA ECMO in patients with cardiogenic shock secondary to sepsis is reviewed.

Use of ECMO in Sepsis and Septic Shock

“…After this review, several case reports on bacterial septic shock were published [21,22]. A 24-year-old multiparous woman was admitted with multiple organ failure in the third trimester of pregnancy [21], after suffering from high fever and diarrhea since 1 day.…”

“…In a very recent case report [22], another 24-year-old was readmitted to the hospital 2 days after a normal vaginal delivery following an uneventful pregnancy. Despite starting vasopressors and broad-spectrum antibiotics, she continued to decline with intubation 14 h after admission.…”

Outcomes in patients requiring repeat extracorporeal membrane oxygenation

“…Extracorporeal membrane oxygenation (ECMO) support is now being used for expanded indications including stabilization of patients in cardiogenic shock prior to definitive cardiac surgery, and for hemodynamic support in patients with non‐cardiogenic shock for etiologies such as sepsis . As the number of patients requiring ECMO increases nationwide, a number of patients may require ECMO more than once.…”

Repeat extracorporeal membrane oxygenation support-Are the results better the second time around?

“…Extracorporeal membrane oxygenation (ECMO) has emerged as an important intervention for patients with hemodynamic instability. It has expanded from being used primarily for the treatment of respiratory failure in neonates, to stabilizing patients in cardiogenic shock before and after cardiac surgery, and for hemodynamic support in patients with circulatory collapse from sepsis . As is the case with all cardiac procedures, a percentage of patients will require a repeat procedure in their lifetime.…”

“…It has expanded from being used primarily for the treatment of respiratory failure in neonates, to stabilizing patients in cardiogenic shock before and after cardiac surgery, and for hemodynamic support in patients with circulatory collapse from sepsis. 1,2 As is the case with all cardiac procedures, a percentage of patients will require a repeat procedure in their lifetime. This is more common in redo valve surgery where reoperative surgery may be performed three or four times with an in-hospital mortality of 5.8% and a 20-year survival as high as 60%.…”