Use of Venoarterial Extracorporeal Membrane Oxygenation (VA-ECMO) in an Adult Patient with Septic and Cardiogenic Shock
A.C.F.F., female, 40 years old, on her 20th week of pregnancy with twins, without cardiac prior history, presented mild pelvic pain and vaginal bleeding. By ultrasonography, a protusion of the amniotic sac was observed. On the second day of hospitalization, a failed attempt to inhibit preterm labor was performed, resulting in the rupture of the amniotic sac of one of the fetuses. After 24 h, the patient was diagnosed with septic abortion and uterine infection. Hysterectomy was made due to severe septic endometritis. During the procedure, the patient had two episodes of cardiorespiratory arrest, both rapidly reversed. After the surgery, she was transferred to an intensive care unit with tachycardia (HR 159 bpm) and shock (MAP 60 mmHg). Evaluation by transthoracic echocardiography (TTE) revealed severe left ventricular dysfunction, with an estimated ejection fraction of 18%, requiring supramaximal doses of vasoactive drugs. Considering the patient’s clinical history and evolution, ECMO was installed in the venoarterial mode. After 6 days of mechanical circulatory assistance, a TTE was performed, and an improvement in the cardiac function was identified, with LVEF at 70%. Considering the improvement in cardiac function, ECMO explantation was made. Four days after ECMO withdrawal, bilateral amputation of the infrapatellar region of the lower limbs, left upper forearm (as shown in Fig. 2), and right upper limb digital pulps was performed. One week after explantation of the circulatory assistance device, the patient developed a new sepsis episode resulting in her death.
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