From crisis to recovery: A case report on nursing strategies for hepatitis E post-cardiac arrest.

RATIONALE

Extracorporeal membrane oxygenation (ECMO) is a life-support technology for refractory cardiac arrest, but the massive blood transfusions required during treatment significantly increase the risk of transfusion-related infections. Hepatitis E virus (HEV) - traditionally linked to fecal-oral transmission - is increasingly recognized as a transfusion-transmitted pathogen, especially in emergency settings where urgent blood product infusion is common and routine HEV screening in blood banks is often lacking. However, nursing strategies for managing acute HEV infection after ECMO remain poorly defined, highlighting the need to address this clinical gap.

PATIENT CONCERNS

A 35-year-old female nurse developed sudden cardiac arrest due to idiopathic ventricular fibrillation and underwent ECMO. Post-ECMO, she received red blood cells and plasma transfusions. On postoperative day 15, she had worsening liver function (alanine aminotransferase 938 U/L, total bilirubin 69.3 μmol/L) and abnormal coagulation function (prothrombin time [PT] 14.5 seconds), along with intermittent low-grade fever (37.3-38.0°C); subsequent jaundice of the skin, sclera, and urine developed.

DIAGNOSES

Next-generation sequencing confirmed acute HEV infection. The diagnosis was further supported by typical liver function abnormalities (marked elevation of transaminases and bilirubin), abnormal coagulation (PT 14.5 seconds), and clinical manifestations of HEV infection (fever, jaundice), with no evidence of other etiologies (e.g., viral hepatitis A/B/C, drug-induced liver injury).

INTERVENTIONS

Comprehensive nursing and clinical interventions were implemented. Daily monitoring: liver function (alanine aminotransferase, aspartate aminotransferase, bilirubin), coagulation status (with focus on PT, e.g., baseline PT 14.5 seconds), and jaundice-related symptoms (skin/sclera color, pruritus, urine color); gastrointestinal management: Bacillus licheniformis (0.5 g twice daily) to regulate intestinal flora, and lactulose (15 mL twice daily) to promote bowel movement, maintaining gut-liver axis balance; personalized nutritional support: Collaboration with the nutrition department to provide a low-fat semi-liquid diet (1500-1600 kcal/d, 75-80 g branched-chain amino acid-rich protein, and adequate vitamins/minerals); and cardiac follow-up: planning and implementation of implantable cardioverter defibrillator (ICD) implantation on postoperative day 50 (after resolution of liver injury and stabilization of coagulation function).

OUTCOMES

After 49 days of hospitalization, the patient's liver function normalized (total bilirubin within normal range, albumin increased from 31.3 to 35.1 g/L), coagulation function (PT) returned to normal, and jaundice resolved. She successfully underwent ICD implantation on postoperative day 50. A 3-month follow-up showed no chronic liver damage, and serum HEV-IgM turned negative at 6 months; no malignant arrhythmias or ICD discharges were recorded during follow-up.

LESSONS

This case emphasizes 3 key lessons: Firstly, for patients receiving ECMO and blood transfusions, close monitoring of liver function, coagulation indicators (e.g., PT), and clinical signs of HEV infection (fever, jaundice) is critical for early diagnosis; secondly, multimodal interventions - combining targeted monitoring (including coagulation tracking), gut-liver axis regulation, and personalized nutrition - are effective for managing acute HEV infection post-ECMO; and thirdly, timing of ICD implantation (e.g., postoperative day 50, after liver and coagulation stabilization) and collaboration between nursing teams, nutrition departments, and cardiac specialists ensure holistic care, supporting both liver recovery and long-term cardiac safety.