Management of a severe abdominal compartment complicating fulminant cardiogenic-septic shock: An abdominal arterio-venous single-tube ECMO bypass saved a young patient's life after OHCA.
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| Abstract | INTRODUCTION: In severe cardiogenic shock, for example, following cardiac arrest, the implantation of an extracorporeal hemodynamic assist device often seems to be the last option to save a patient's life. However, even though our guidelines provide a class-IIa-recommendation to implant a veno-arterial extracorporeal membrane oxygenation (vaECMO) device in these patients, the accompanying disease- and device-associated complications and their consequences remain challenging to handle. CASE PRESENTATION: A 43-year-old patient presented with severe cardiogenic-septic shock with a complicating abdominal compartment due to a prolonged out-of-hospital cardiac arrest (OHCA). A loss of function of the vaECMO, implanted immediately after admission, impended due to increasing intra-abdominal pressure. This dangerous situation was resolved by crafting an experimental "arterio-venous shunt," using the side port of the reinfusion (arterial) vaECMO cannula and a downstream large-volume central access in the right femoral vein toward the abdominal venous system, which led to the patient's full recovery. CONCLUSION: In patients with cardiogenic shock, the use of catecholamines and implantation of extracorporeal assist devices alone do not ensure successful therapy. To optimize the outcome, device- and disease-associated complications must also be managed in a timely and minimally invasive procedure.
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| Authors | Julian Kreutz, Amar Mardini, Ann-Christin Schäfer, Bernhard Schieffer, Birgit Markus |
| Journal | Perfusion (Perfusion) Vol. 38 Issue 4 Pg. 876-880 (05 2023) ISSN: 1477-111X [Electronic] England |
| PMID | 35400212 (Publication Type: Case Reports, Journal Article) |
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