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Cardiogenic shock with highly complicated course after influenza A virus infection treated with vva-ECMO and Impella CP (ECMELLA): a case report.
Ebert, Daniel; Mungard, Nils; Mensch, Alexander; Homeister, Lorenz; Willsch, Jan; Ibe, Richard; Baust, Henning; Stiller, Markus; Rebelo, Artur; Ukkat, Joerg; Rigopoulos, Angelos G; Weber, Elke; Bucher, Michael; Noutsias, Michel.
  • Ebert D; Department of Anesthesiology, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Strasse 40, 06120, Halle (Saale), Germany.
  • Mungard N; Department of Anesthesiology, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Strasse 40, 06120, Halle (Saale), Germany.
  • Mensch A; Department of Neurology, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Strasse 40, 06120, Halle (Saale), Germany.
  • Homeister L; Department of Anesthesiology, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Strasse 40, 06120, Halle (Saale), Germany.
  • Willsch J; Department of Cardiac Surgery, Mid-German Heart Center, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Strasse 40, 06120, Halle (Saale), Germany.
  • Ibe R; Department of Neurology, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Strasse 40, 06120, Halle (Saale), Germany.
  • Baust H; Department of Anesthesiology, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Strasse 40, 06120, Halle (Saale), Germany.
  • Stiller M; Department of Cardiac Surgery, Mid-German Heart Center, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Strasse 40, 06120, Halle (Saale), Germany.
  • Rebelo A; Department of Vascular Surgery, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Strasse 40, 06120, Halle (Saale), Germany.
  • Ukkat J; Department of Vascular Surgery, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Strasse 40, 06120, Halle (Saale), Germany.
  • Rigopoulos AG; Division of Cardiology, Angiology and Intensive Medical Care, Department of Internal Medicine III (KIM III), Mid-German Heart Center, Faculty of Medicine, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Strasse 40, 06120, Halle (Saale), Germany.
  • Weber E; Department of Adult Cardiology, Mitera General Hospital, Hygeia Group, 6 Erythrou Stavrou Street, 15123, Marousi, Athens, Greece.
  • Bucher M; Department of Anesthesiology, St. Elisabeth & St. Barbara Hospital Halle, Mauerstrasse 5, 06110, Halle (Saale), Germany.
  • Noutsias M; Department of Anesthesiology, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Strasse 40, 06120, Halle (Saale), Germany.
BMC Cardiovasc Disord ; 21(1): 528, 2021 11 08.
Article in English | MEDLINE | ID: covidwho-1505900
ABSTRACT

BACKGROUND:

The value of mechanical circulatory support (MCS) in cardiogenic shock, especially the combination of the ECMELLA approach (Impella combined with ECMO), remains controversial. CASE PRESENTATION A previously healthy 33-year-old female patient was submitted to a local emergency department with a flu-like infection and febrile temperatures up to 39 °C. The patient was tested positive for type-A influenza, however negative for SARS-CoV-2. Despite escalated invasive ventilation, refractory hypercapnia (paCO2 22 kPa) with severe respiratory acidosis (pH 6.9) and a rising norepinephrine rate occurred within a few hours. Due to a Horovitz-Index < 100, out-of-centre veno-venous extracorporeal membrane oxygenation (vv-ECMO)-implantation was performed. A CT-scan done because of anisocoria revealed an extended dissection of the right vertebral artery. While the initial left ventricular function was normal, echocardiography revealed severe global hypokinesia. After angiographic exclusion of coronary artery stenoses, we geared up LV unloading by additional implantation of an Impella CP and expanded the vv-ECMO to a veno-venous-arterial ECMO (vva-ECMO). Clinically relevant bleeding from the punctured femoral arteries resulted in massive transfusion and was treated by vascular surgery later on. Under continued MCS, LVEF increased to approximately 40% 2 days after the initiation of ECMELLA. After weaning, the Impella CP was explanted at day 5 and the vva-ECMO was removed on day 9, respectively. The patient was discharged in an unaffected neurological condition to rehabilitation 25 days after the initial admission.

CONCLUSIONS:

This exceptional case exemplifies the importance of aggressive MCS in severe cardiogenic shock, which may be especially promising in younger patients with non-ischaemic cardiomyopathy and potentially reversible causes of cardiogenic shock. This case impressively demonstrates that especially young patients may achieve complete neurological restoration, even though the initial prognosis may appear unfavourable.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Influenza A virus / Respiration, Artificial / Respiratory Insufficiency / Extracorporeal Membrane Oxygenation / Heart-Assist Devices / Ventricular Dysfunction, Left / Influenza, Human Type of study: Case report / Diagnostic study / Observational study / Prognostic study / Randomized controlled trials Topics: Long Covid Limits: Adult / Female / Humans Language: English Journal: BMC Cardiovasc Disord Journal subject: Vascular Diseases / Cardiology Year: 2021 Document Type: Article Affiliation country: S12872-021-02346-2

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Influenza A virus / Respiration, Artificial / Respiratory Insufficiency / Extracorporeal Membrane Oxygenation / Heart-Assist Devices / Ventricular Dysfunction, Left / Influenza, Human Type of study: Case report / Diagnostic study / Observational study / Prognostic study / Randomized controlled trials Topics: Long Covid Limits: Adult / Female / Humans Language: English Journal: BMC Cardiovasc Disord Journal subject: Vascular Diseases / Cardiology Year: 2021 Document Type: Article Affiliation country: S12872-021-02346-2