Management of a severe abdominal compartment complicating fulminant cardiogenic-septic shock: An abdominal arterio-venous single-tube ECMO bypass saved a young patient’s life after OHCA

Abstract

Introduction In severe cardiogenic shock, for example, following cardiac arrest, the implantation of an extracorporeal hemodynamic assist device often seems to be the last option to save a patient’s life. However, even though our guidelines provide a class-IIa-recommendation to implant a veno-arterial extracorporeal membrane oxygenation (vaECMO) device in these patients, the accompanying disease- and device-associated complications and their consequences remain challenging to handle. Case presentation A 43-year-old patient presented with severe cardiogenic-septic shock with a complicating abdominal compartment due to a prolonged out-of-hospital cardiac arrest (OHCA). A loss of function of the vaECMO, implanted immediately after admission, impended due to increasing intra-abdominal pressure. This dangerous situation was resolved by crafting an experimental “arterio-venous shunt,” using the side port of the reinfusion (arterial) vaECMO cannula and a downstream large-volume central access in the right femoral vein toward the abdominal venous system, which led to the patient’s full recovery. Conclusion In patients with cardiogenic shock, the use of catecholamines and implantation of extracorporeal assist devices alone do not ensure successful therapy. To optimize the outcome, device- and disease-associated complications must also be managed in a timely and minimally invasive procedure.