Cardiogenic shock with highly complicated course after influenza A virus infection treated with vva-ECMO and Impella CP (ECMELLA): a case report

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 dep...

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Autores principales:	Daniel Ebert, Nils Mungard, Alexander Mensch, Lorenz Homeister, Jan Willsch, Richard Ibe, Henning Baust, Markus Stiller, Artur Rebelo, Joerg Ukkat, Angelos G. Rigopoulos, Elke Weber, Michael Bucher, Michel Noutsias
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Cardiogenic shock Case report ECMO Impella Mechanical circulatory support Myocarditis Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/9aad95d778ac48e2b990cf46b6bb7644
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spelling	oai:doaj.org-article:9aad95d778ac48e2b990cf46b6bb76442021-11-14T12:07:38ZCardiogenic shock with highly complicated course after influenza A virus infection treated with vva-ECMO and Impella CP (ECMELLA): a case report10.1186/s12872-021-02346-21471-2261https://doaj.org/article/9aad95d778ac48e2b990cf46b6bb76442021-11-01T00:00:00Zhttps://doi.org/10.1186/s12872-021-02346-2https://doaj.org/toc/1471-2261Abstract 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.Daniel EbertNils MungardAlexander MenschLorenz HomeisterJan WillschRichard IbeHenning BaustMarkus StillerArtur RebeloJoerg UkkatAngelos G. RigopoulosElke WeberMichael BucherMichel NoutsiasBMCarticleCardiogenic shockCase reportECMOImpellaMechanical circulatory supportMyocarditisDiseases of the circulatory (Cardiovascular) systemRC666-701ENBMC Cardiovascular Disorders, Vol 21, Iss 1, Pp 1-7 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Cardiogenic shock Case report ECMO Impella Mechanical circulatory support Myocarditis Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	Cardiogenic shock Case report ECMO Impella Mechanical circulatory support Myocarditis Diseases of the circulatory (Cardiovascular) system RC666-701 Daniel Ebert Nils Mungard Alexander Mensch Lorenz Homeister Jan Willsch Richard Ibe Henning Baust Markus Stiller Artur Rebelo Joerg Ukkat Angelos G. Rigopoulos Elke Weber Michael Bucher Michel Noutsias Cardiogenic shock with highly complicated course after influenza A virus infection treated with vva-ECMO and Impella CP (ECMELLA): a case report
description	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.
format	article
author	Daniel Ebert Nils Mungard Alexander Mensch Lorenz Homeister Jan Willsch Richard Ibe Henning Baust Markus Stiller Artur Rebelo Joerg Ukkat Angelos G. Rigopoulos Elke Weber Michael Bucher Michel Noutsias
author_facet	Daniel Ebert Nils Mungard Alexander Mensch Lorenz Homeister Jan Willsch Richard Ibe Henning Baust Markus Stiller Artur Rebelo Joerg Ukkat Angelos G. Rigopoulos Elke Weber Michael Bucher Michel Noutsias
author_sort	Daniel Ebert
title	Cardiogenic shock with highly complicated course after influenza A virus infection treated with vva-ECMO and Impella CP (ECMELLA): a case report
title_short	Cardiogenic shock with highly complicated course after influenza A virus infection treated with vva-ECMO and Impella CP (ECMELLA): a case report
title_full	Cardiogenic shock with highly complicated course after influenza A virus infection treated with vva-ECMO and Impella CP (ECMELLA): a case report
title_fullStr	Cardiogenic shock with highly complicated course after influenza A virus infection treated with vva-ECMO and Impella CP (ECMELLA): a case report
title_full_unstemmed	Cardiogenic shock with highly complicated course after influenza A virus infection treated with vva-ECMO and Impella CP (ECMELLA): a case report
title_sort	cardiogenic shock with highly complicated course after influenza a virus infection treated with vva-ecmo and impella cp (ecmella): a case report
publisher	BMC
publishDate	2021
url	https://doaj.org/article/9aad95d778ac48e2b990cf46b6bb7644
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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

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