Parallel Venovenous and Venoarterial Extracorporeal Membrane Oxygenation for Differential Titration of Cardiopulmonary Support in Combined Severe Cardiac and Respiratory Failure: A Case Report.

Parallel venovenous (VV) and venoarterial (VA) extracorporeal membrane oxygenation (ECMO) can allow separate titration of respiratory and circulatory support in patients with concurrent severe cardiopulmonary failure. A 64-year-old woman with central hypopituitarism developed cytomegalovirus infection with hemophagocytic lymphohistiocytosis, followed by severe Pseudomonas aeruginosa pneumonia and septic cardiomyopathy. Despite VV-ECMO and intra-aortic balloon pump support, refractory cardiogenic shock required the addition of VA-ECMO. After parallel ECMO was initiated, hemodynamics improved rapidly, and vasopressors were discontinued within 4 hours. A key feature of this case was the transition from VA-dominant to VV-dominant support as myocardial function recovered while respiratory failure continued to require VV-ECMO. VA-ECMO was discontinued on hospital day 17, and VV-ECMO was removed on hospital day 28. The patient was discharged for rehabilitation on hospital day 109. This case illustrates that parallel VV- and VA-ECMO may provide rescue support for selected patients with refractory cardiopulmonary failure when conventional ECMO configurations are insufficient.