• A&A practice · Apr 2020

    Case Reports

    Dual RVAD-ECMO Circuits to Treat Cardiogenic Shock and Hypoxemia Due to Necrotizing Lung Infection: A Case Report.

    • Andrew N Rosenbaum, John K Bohman, Kent H Rehfeldt, John M Stulak, Richard C Daly, Allan M Klompas, Atta Behfar, and Suraj M Yalamuri.
    • From the Department of Cardiovascular Diseases.
    • A A Pract. 2020 Apr 1; 14 (6): e01181.

    AbstractUtilization of venoarterial extracorporeal membrane oxygenation (VA-ECMO) is expanding, but dual VA-ECMO circuits to treat cardiogenic shock with refractory hypoxemia is unreported. We describe the case of combined cardiogenic and distributive shock due to necrotizing pulmonary blastomycosis. After initial central VA-ECMO cannulation, acute respiratory distress syndrome (ARDS) with increasing shunt resulted in significant central hypoxemia due to progressive ventilation-perfusion mismatch. An additional circuit provided complete oxygenation of the high circulating volume. After 4 months on support, he underwent successful heart-lung-kidney transplantation. Dual ECMO circuits are technically feasible and may be advantageous in specific circumstances of high pulmonary shunting resulting in excessive hypoxemia unbalanced with appropriate oxygen delivery.

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