Otsuru Wataru, Nishihara Masaaki, Hatakeyama Kiwamu, Iyonaga Takeshi, Fujino Takeo, Sakamoto Takafumi, Shono Yuji, Abe Kohtaro, Shiose Akira, Akahoshi Tomohiko
Emergency and Critical Care Center, Kyushu University Hospital, Fukuoka, Japan.
Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan.
Medicine (Baltimore). 2025 Aug 8;104(32):e43741. doi: 10.1097/MD.0000000000043741.
Streptococcal toxic shock syndrome (STSS) is an invasive Streptococcus pyogenes infection characterized by hypotension and multiple organ failure with rapid progression and high mortality. Although extracorporeal membrane oxygenation (ECMO) has been used in adults with STSS, mortality remains high and optimal mechanical circulatory support is controversial. Veno-arterial ECMO has specific complications in severe cardiopulmonary failure, including differential hypoxia and increased left ventricular end-diastolic pressure due to retrograde flow.
A 51-year-old man presented to the emergency department with fever and dyspnea, progressing rapidly from an initially diagnosed upper respiratory tract infection to severe respiratory distress and refractory shock requiring oxygen supplementation and vasopressor support.
The patient was diagnosed with STSS, which manifested as septic shock with severe cardiopulmonary compromise.
We implemented a combined approach using veno-arteriovenous ECMO (V-AV ECMO) and Impella CP® support (veno-arteriovenous extracorporeal membrane oxygenation and Impella [VAVEcpella]). This strategy provided oxygenated blood to the right heart while achieving left ventricular unloading. This was done in conjunction with appropriate antibiotic therapy and source control measures.
The novel VAVEcpella approach successfully supported the patient through severe cardiopulmonary failure secondary to STSS-induced septic shock. To our knowledge, this is the first reported case of VAVEcpella implementation specifically for the management of STSS.
The VAVEcpella approach (combined V-AV ECMO and Impella support) may represent a viable rescue strategy for patients with severe cardiopulmonary failure secondary to septic shock, such as STSS, where traditional support methods have shown limited success.
链球菌中毒性休克综合征（STSS）是一种侵袭性化脓性链球菌感染，其特征为低血压和多器官功能衰竭，病情进展迅速且死亡率高。尽管体外膜肺氧合（ECMO）已用于成人STSS患者，但死亡率仍然很高，最佳机械循环支持存在争议。静脉-动脉ECMO在严重心肺衰竭中有特定并发症，包括因逆向血流导致的差异缺氧和左心室舒张末期压力升高。
一名51岁男性因发热和呼吸困难就诊于急诊科，最初诊断为上呼吸道感染，病情迅速进展为严重呼吸窘迫和难治性休克，需要吸氧和血管升压药支持。
患者被诊断为STSS，表现为伴有严重心肺功能损害的感染性休克。
我们采用了静脉-动脉-静脉ECMO（V-AV ECMO）和Impella CP®支持相结合的方法（静脉-动脉-静脉体外膜肺氧合和Impella [VAVEcpella]）。该策略在实现左心室卸载的同时为右心提供氧合血。这与适当的抗生素治疗和源头控制措施同时进行。
新型VAVEcpella方法成功支持患者度过了由STSS引起的感染性休克继发的严重心肺衰竭。据我们所知，这是首例专门报道的采用VAVEcpella治疗STSS的病例。
VAVEcpella方法（联合V-AV ECMO和Impella支持）可能是继发于感染性休克（如STSS）的严重心肺衰竭患者的一种可行的挽救策略，而传统支持方法在此类患者中效果有限。
