Veno-Venoarterial Extracorporeal Membrane Oxygenation for Septic Cardiomyopathy Caused by Invasive Pneumococcal Infection: A Case Report.

The efficacy of extracorporeal membrane oxygenation (ECMO) for circulatory support in septic shock, especially hybrid ECMO, remains uncertain. A 30-year-old woman presented with septic shock caused by invasive pneumococcal infection, requiring intensive care unit (ICU) admission. Despite maximal respiratory support, her condition worsened with a partial pressure of oxygen (PaO2)/fraction of inspired oxygen (FiO2) ratio < 60 (The ratio is an indicator of respiratory oxygenation), indicating severe hypoxia and requiring the initiation of veno-venous (V-V) ECMO within three hours. Progressive circulatory failure followed, marked by reduced cardiac function indicative of septic cardiomyopathy; septic cardiomyopathy is a reversible myocardial dysfunction that occurs in patients with sepsis. Transition to veno-venoarterial (V-VA) ECMO took place 13 hours after admission. Liberation from veno-arterial (V-A) ECMO on day 9 and V-V ECMO on day 16 paralleled improvements in circulatory and respiratory functions. Necrosis of both lower extremities, pneumonia and bloodstream infection caused by Pseudomonas aeruginosa, prolonged ICU stay until discharge on day 52. Weaned off the ventilator, and with fully recovered consciousness and cardiac function, she was transferred to a rehabilitation facility on day 89. At follow-up more than six months after disease onset, she was doing well and continuing rehabilitation. This case enhances our understanding that when septic cardiomyopathy causes circulatory failure early in the treatment of septic shock, ECMO can serve as life-saving circulatory support. Additionally, the successful use of V-VA ECMO in this case highlights its potential as a therapeutic strategy for patients with severe respiratory failure complicated by septic cardiomyopathy, especially those initially managed with V-V ECMO. Timely transition to V-VA ECMO may improve outcomes in septic patients receiving V-V ECMO when cardiac dysfunction worsens due to septic cardiomyopathy.