Asaki Motohiro, Masuda Takamitsu, Miki Yasuo
Department of Emergency Medicine, Emergency and Critical Care Center, Fujieda Municipal General Hospital, Shizuoka, Japan.
Case Rep Crit Care. 2018 Oct 22;2018:6973197. doi: 10.1155/2018/6973197. eCollection 2018.
A 57-year-old man presented to the emergency department with fever and progressive altered level of consciousness of 5 days' duration. Three days before admission, influenza A was diagnosed at a clinic. On admission, his vital signs were unstable. Pneumonia was diagnosed through chest computed tomography, and urinary antigen test was positive. A diagnosis of septic shock due to and influenza pneumonia was made, and critical care management was initiated, including mechanical ventilation and vasopressors. However, tachycardia did not improve, left ventricular ejection fraction was 20%, and circulatory insufficiency progressed. Therefore, considering the involvement of septic cardiomyopathy and cardiogenic shock, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) was initiated for circulation assistance on day 3 since admission. Tachycardia and myocardial dysfunction improved by day 8, and VA-ECMO was withdrawn. Subsequently, nutrition management and rehabilitation were performed, and the patient was transferred to a recovery hospital on day 108. VA-ECMO may be beneficial when concomitant with circulatory assistance in uncontrollable cases of septic cardiomyopathy using catecholamines and -blockers. It may be necessary to adopt VA-ECMO at an appropriate time before the patient progresses to cardiopulmonary arrest.
一名57岁男性因发热和意识水平进行性改变5天而就诊于急诊科。入院前3天，在一家诊所被诊断为甲型流感。入院时，他的生命体征不稳定。通过胸部计算机断层扫描诊断为肺炎，尿抗原检测呈阳性。诊断为甲型流感肺炎所致感染性休克，并开始进行重症监护管理，包括机械通气和使用血管活性药物。然而，心动过速没有改善，左心室射血分数为20%，循环功能不全进展。因此，考虑到感染性心肌病和心源性休克的影响，入院后第3天开始进行静脉-动脉体外膜肺氧合（VA-ECMO）以辅助循环。到第8天心动过速和心肌功能障碍有所改善，VA-ECMO撤离。随后，进行营养管理和康复治疗，患者于第108天转至康复医院。在使用儿茶酚胺和β受体阻滞剂治疗无法控制的感染性心肌病病例中，VA-ECMO与循环辅助同时使用可能有益。在患者进展至心肺骤停之前的适当时间采用VA-ECMO可能是必要的。
