Porizka Michal, Rulisek Jan, Flaksa Marek, Otahal Michal, Lips Michal, Belohlavek Jan, Balik Martin
Department of Anaesthesiology, Resuscitation and Intensive Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic.
2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic.
Perfusion. 2022 Apr;37(3):306-310. doi: 10.1177/0267659121998962. Epub 2021 Feb 26.
The hypodynamic septic shock appears to be a promising indication to veno-arterial membrane oxygenation (VA-ECMO) support of a patient with insufficient cardiac output. With cardiac recovery most of those patients progress into a hyperdynamic septic shock with cardiac output, which may not match critically low systemic vascular resistance to maintain perfusion pressures. Such refractory distributive shock represents a challenging indication to VA-ECMO. We report a rare case of a 27-year old patient who developed severe refractory hypodynamic septic shock due to the bilateral staphylococcal pneumonia and had to be initially rescued by femoro-femoral VA-ECMO. Despite extensive measures, he remained in intractable hypotension and profound tissue hypoperfusion with imminent multiorgan failure. The commencement of a second jugulo-axillary VA ECMO secured a total blood flow of 14.3 L/min, which restored perfusion pressure and successfully bridged patient over the period of critical haemodynamic instability and ultimately may have facilitated recovery.
低动力型感染性休克似乎是对心输出量不足的患者进行静脉-动脉膜肺氧合（VA-ECMO）支持的一个有前景的适应证。随着心脏功能恢复，这些患者中的大多数会进展为高动力型感染性休克伴心输出量增加，而这一心输出量可能无法匹配极低的体循环血管阻力以维持灌注压力。这种难治性分布性休克是VA-ECMO的一个具有挑战性的适应证。我们报告了一例罕见病例，一名27岁患者因双侧金黄色葡萄球菌肺炎发展为严重难治性低动力型感染性休克，最初不得不通过股-股VA-ECMO进行抢救。尽管采取了广泛的措施，他仍处于顽固性低血压和严重的组织低灌注状态，并有多器官功能衰竭的风险。启动第二个颈内静脉-腋动脉VA ECMO后，总血流量达到14.3 L/min，恢复了灌注压力，并成功地使患者度过了关键的血流动力学不稳定期，最终可能促进了康复。
