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ABSTRACT
Sepsis-induced cardiomyopathy is life threatening. Placement of an ECLS in patients with myocardial dysfunction could be considered in certain cases, especially after cardiotomy. We report a particular case of septic shock with a cardiac dysfunction requiring the placement of extracorporeal life support (ECLS) in the aftermath of an atrio-esophageal fistula (following an AF ablation procedure by radio frequency) surgically repaired under extra-corporeal circulation (ECC). Despite this promising technique, the shock was irreversible and refractory to therapy, and the patient died.
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References
- Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The Third international Consensus Definition for Sepsis and Septic Shock (Sepsis-3) JAMA. 2016 feb23;315(8) :801.
- Vincent J-L, De Backer D. Circulatory shock. N Engl J Med. 2013 Oct 31 ;369(18):1726-34.
- Bone RC, Balk RA, Cerra FB et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest 1992; 101: 1644-55.
- (6) Fleischmann C, Scherag A, Adhikari NKJ, Hartog CS, Tsaganos T, Schlattmann P, et al. Assessment of Global Incidence and mortality of hospital-treated sepsis. Current estimates and limitations. Am J respir Care Med. 2016 Feb 1 ;193(3):259-72.
- Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer M, et al. Surviving Sepsis Campaign/ International Guidelines for Management of Sepsis and Septic and Septic Shock. Crit Care Med. 2007 Mar ;45(3):486-552.
- -Doll N, Fabricius A, Borger MA, Bucerius J, Doll S, Kramer K, Ullmann C, Schmitt DV, Walther T, Falk V, Mohr FW, (2003) Temporary extracorporeal membrane oxygenation in patients with refractory postoperative cardiogenic shock-a single center experience. J Card Surg 18: 512–518
- -Diagne PA, D’Ostrevy N, Lambert C, Geoffroy E, Eljezi V, Médard A, Farhat M, Innorta A, Miguel B, Legault B, Azarnoush K, Camilleri L. Extra corporeal life support (ECLS) post-cardiotomie, le site de canulation a-t-il une importance sur les résultats ? Journal de chirurgie thoracique et cardio-vasculaire 2018 ;22(1). doi: 10.24399/JCTCV22-1-DIA
- Russell JA, Rush B, Boyd J. Pathophysiology of Septic Shock. Crit Care Clin. 2018 Jan;34(1):43-61.
- Jardin F, Brun-Ney D, Auvert B et al. Sepsis-related cardiogenic shock. Crit Care Med 1990;18:1055-60.
- Vieillard-Baron A, Caille V, Charron C et al. Actual incidence of global left ventricular hypokinesia in adult septic shock. Crit Care Med 2008; 36:1701-6.
- Combes A, Leprince P, Luyt C-E, Bonnet N, Trouillet J-L, Léger P, et al. Outcomes and long-termquality-of-life of patients supported by extracorporeal membrane oxygenation for refractory cardiogenic shock. Crit Care Med. 2008 May;36(5):1404–11.
- Weisel RD, Vito L, Dennis RC, Valeri CR, Hechtman HB. Myocardial depression during sepsis. Am J Surg. 1977 Apr1;133(4):512-21.
- Parker MM, Shelhamer JH, Bacharach SL, Green MV, Natanson C, Frederick TM, et al. Profound but reversible myocardial depression in patients with septic shock. Ann Intern Med. 1984 Apr;100(4):483-90.
- Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock. Crit Care Med. 2017 Mar ;45(3):486-552.
- Mac Laren G, Pellegrino V, Butt W et al. Successful use of ECMO in adults with life-threatening infections. Anaesth Intensive Care 2004; 32: 707-10.
- Vohra HA, Jones C, Viola N et al. Use of extra corporeal membrane oxygenation in the management of sepsis secondary to an infected right ventricle-to-pulmonary artery Contegra conduit in an adult patient. Interact Cardio vasc Thorac Surg2009; 8: 272-4.
- Jacquemet PJ. Cardiomyopathie septique et assistance circulatoire. Revue de la littérature et expérience lyonnaise sur 12 ans. Médecine humaine et pathologie. 2019;54-60.
- Park TK, Yang JH, Jeon K, Choi JH, Gwon HC et al. Extracorporeal membrane oxygenation for refractory septic shock in adults. Eur J Cardiothorac Surg.2015 Feb 1;47(2) :e68-74.
- Ohra HA, Adamson L, Weeden DF et al. Use of extra corporeal membrane oxygenation in the management of septic shock with severe cardiac dysfunction after Ravitch procedure.
- Ann Thorac Surg 2009; 87: e4-5.
- Dietl CA, Wernly JA, Pett SB et al. Extracorporeal membrane oxygenation support improves survival of patients with severe Hantavirus cardiopulmonary syndrome.
- J Thorac Cardiovasc Surg2008; 135: 579-84.
- Bréchot N, Luyt C-E, Schmidt M, Leprince P, Trouillet J-L, Léger P, et al. Veno arterial extracorporeal membrane oxygenation support for refractory cardiovascular dysfunction during severe bacterial septic shock. Crit Care Med. 2013 Jul;41(7):1616-26.
- Cheng A, Sun HY, Tsai MS, Ko WJ, Tsai PR, Hu FC, et al. Predictors of survival in adults undergoing extracorporeal membrane oxygenation with severe infections. J Thorac Cardiovasc Surg. 2016 ;152(6) :1526-1536.e1.
- Vogel DJ, Murray J, Czapran AZ, Camporota L, Ioannou N, Meadows CI, et al. Veno-arteriovenous ECMO for septic cardiomyopathy: a single-centre experience. Perfusion. 2018;33(1_suppl):57-64.
- Ro SK, Kim WK, Lim JY, Yoo JS, Hong S-B, Kim JB. Extracorporeal life support for adults with refractory septic shock. J Thorac Cardiovasc Surg. 2018 Sep;156(3):1104-1109.e1.
- Carbonnier M. Evaluation de l’implantation d’une assistance cardiaque de type Extra Corporeal Membrane Oxygenation dans la cardiomyopathie septique après une chirurgie cardiaque. Mémoire 2016;24.
- Rich PB, Younger JG, Soldes OS, Awad SS, Bartlett RH. Use of extracorporeal life support for adult patients with respiratory failure and sepsis. ASAIO J Am Soc Artif Intern Organs 1992. 1998 Aug;44(4):263-6.
- Huang C-T, Tsai Y-J, Tsai P-R, Ko W-J. Extracorporeal membrane oxygenation resuscitation in adult patients with refractory septic shock. J Thorac Cardiovasc Surg. 2013 Nov;146(5):1041-6.
- Choi MJ, Ha SO, Kim HS, Park S, Han SJ, Lee SH. The Simplified Acute Physiology Score II as a Predictor of Mortality in Patients Who Under went Extracorporeal Membrane Oxygenation for Septic Shock. Ann Thorac Surg. 2017 Apr;103(4):1246–53.
- Von Bahr V, Hultman J, Eksborg S, Frenckner B, Kalzén H. Long-Term Survival in Adults Treated With Extracorporeal Membrane Oxygenation for Respiratory Failure and Sepsis. Crit Care Med. 2017 Feb;45(2):164–70.
- Banjas N, Hopf H-B, Hanisch E, Friedrichson B, Fichte J, Buia A. ECMO-treatment in patients with acute lung failure, cardiogenic, and septic shock: mortality and ECMO-learning curve over a 6- year period. J Intensive Care [Internet]. 2018 Dec;6(1). Availablefrom:https://jintensivecare.biomedcentral.com/articles/10.1186/s40560-018-0352-2.
- Falk L, Hultman J, Broman LM. Extracorporeal Membrane Oxygenation for Septic Shock. Crit Care Med. 2019 Aug;47(8):1097.
References
Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The Third international Consensus Definition for Sepsis and Septic Shock (Sepsis-3) JAMA. 2016 feb23;315(8) :801.
Vincent J-L, De Backer D. Circulatory shock. N Engl J Med. 2013 Oct 31 ;369(18):1726-34.
Bone RC, Balk RA, Cerra FB et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest 1992; 101: 1644-55.
(6) Fleischmann C, Scherag A, Adhikari NKJ, Hartog CS, Tsaganos T, Schlattmann P, et al. Assessment of Global Incidence and mortality of hospital-treated sepsis. Current estimates and limitations. Am J respir Care Med. 2016 Feb 1 ;193(3):259-72.
Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer M, et al. Surviving Sepsis Campaign/ International Guidelines for Management of Sepsis and Septic and Septic Shock. Crit Care Med. 2007 Mar ;45(3):486-552.
-Doll N, Fabricius A, Borger MA, Bucerius J, Doll S, Kramer K, Ullmann C, Schmitt DV, Walther T, Falk V, Mohr FW, (2003) Temporary extracorporeal membrane oxygenation in patients with refractory postoperative cardiogenic shock-a single center experience. J Card Surg 18: 512–518
-Diagne PA, D’Ostrevy N, Lambert C, Geoffroy E, Eljezi V, Médard A, Farhat M, Innorta A, Miguel B, Legault B, Azarnoush K, Camilleri L. Extra corporeal life support (ECLS) post-cardiotomie, le site de canulation a-t-il une importance sur les résultats ? Journal de chirurgie thoracique et cardio-vasculaire 2018 ;22(1). doi: 10.24399/JCTCV22-1-DIA
Russell JA, Rush B, Boyd J. Pathophysiology of Septic Shock. Crit Care Clin. 2018 Jan;34(1):43-61.
Jardin F, Brun-Ney D, Auvert B et al. Sepsis-related cardiogenic shock. Crit Care Med 1990;18:1055-60.
Vieillard-Baron A, Caille V, Charron C et al. Actual incidence of global left ventricular hypokinesia in adult septic shock. Crit Care Med 2008; 36:1701-6.
Combes A, Leprince P, Luyt C-E, Bonnet N, Trouillet J-L, Léger P, et al. Outcomes and long-termquality-of-life of patients supported by extracorporeal membrane oxygenation for refractory cardiogenic shock. Crit Care Med. 2008 May;36(5):1404–11.
Weisel RD, Vito L, Dennis RC, Valeri CR, Hechtman HB. Myocardial depression during sepsis. Am J Surg. 1977 Apr1;133(4):512-21.
Parker MM, Shelhamer JH, Bacharach SL, Green MV, Natanson C, Frederick TM, et al. Profound but reversible myocardial depression in patients with septic shock. Ann Intern Med. 1984 Apr;100(4):483-90.
Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock. Crit Care Med. 2017 Mar ;45(3):486-552.
Mac Laren G, Pellegrino V, Butt W et al. Successful use of ECMO in adults with life-threatening infections. Anaesth Intensive Care 2004; 32: 707-10.
Vohra HA, Jones C, Viola N et al. Use of extra corporeal membrane oxygenation in the management of sepsis secondary to an infected right ventricle-to-pulmonary artery Contegra conduit in an adult patient. Interact Cardio vasc Thorac Surg2009; 8: 272-4.
Jacquemet PJ. Cardiomyopathie septique et assistance circulatoire. Revue de la littérature et expérience lyonnaise sur 12 ans. Médecine humaine et pathologie. 2019;54-60.
Park TK, Yang JH, Jeon K, Choi JH, Gwon HC et al. Extracorporeal membrane oxygenation for refractory septic shock in adults. Eur J Cardiothorac Surg.2015 Feb 1;47(2) :e68-74.
Ohra HA, Adamson L, Weeden DF et al. Use of extra corporeal membrane oxygenation in the management of septic shock with severe cardiac dysfunction after Ravitch procedure.
Ann Thorac Surg 2009; 87: e4-5.
Dietl CA, Wernly JA, Pett SB et al. Extracorporeal membrane oxygenation support improves survival of patients with severe Hantavirus cardiopulmonary syndrome.
J Thorac Cardiovasc Surg2008; 135: 579-84.
Bréchot N, Luyt C-E, Schmidt M, Leprince P, Trouillet J-L, Léger P, et al. Veno arterial extracorporeal membrane oxygenation support for refractory cardiovascular dysfunction during severe bacterial septic shock. Crit Care Med. 2013 Jul;41(7):1616-26.
Cheng A, Sun HY, Tsai MS, Ko WJ, Tsai PR, Hu FC, et al. Predictors of survival in adults undergoing extracorporeal membrane oxygenation with severe infections. J Thorac Cardiovasc Surg. 2016 ;152(6) :1526-1536.e1.
Vogel DJ, Murray J, Czapran AZ, Camporota L, Ioannou N, Meadows CI, et al. Veno-arteriovenous ECMO for septic cardiomyopathy: a single-centre experience. Perfusion. 2018;33(1_suppl):57-64.
Ro SK, Kim WK, Lim JY, Yoo JS, Hong S-B, Kim JB. Extracorporeal life support for adults with refractory septic shock. J Thorac Cardiovasc Surg. 2018 Sep;156(3):1104-1109.e1.
Carbonnier M. Evaluation de l’implantation d’une assistance cardiaque de type Extra Corporeal Membrane Oxygenation dans la cardiomyopathie septique après une chirurgie cardiaque. Mémoire 2016;24.
Rich PB, Younger JG, Soldes OS, Awad SS, Bartlett RH. Use of extracorporeal life support for adult patients with respiratory failure and sepsis. ASAIO J Am Soc Artif Intern Organs 1992. 1998 Aug;44(4):263-6.
Huang C-T, Tsai Y-J, Tsai P-R, Ko W-J. Extracorporeal membrane oxygenation resuscitation in adult patients with refractory septic shock. J Thorac Cardiovasc Surg. 2013 Nov;146(5):1041-6.
Choi MJ, Ha SO, Kim HS, Park S, Han SJ, Lee SH. The Simplified Acute Physiology Score II as a Predictor of Mortality in Patients Who Under went Extracorporeal Membrane Oxygenation for Septic Shock. Ann Thorac Surg. 2017 Apr;103(4):1246–53.
Von Bahr V, Hultman J, Eksborg S, Frenckner B, Kalzén H. Long-Term Survival in Adults Treated With Extracorporeal Membrane Oxygenation for Respiratory Failure and Sepsis. Crit Care Med. 2017 Feb;45(2):164–70.
Banjas N, Hopf H-B, Hanisch E, Friedrichson B, Fichte J, Buia A. ECMO-treatment in patients with acute lung failure, cardiogenic, and septic shock: mortality and ECMO-learning curve over a 6- year period. J Intensive Care [Internet]. 2018 Dec;6(1). Availablefrom:https://jintensivecare.biomedcentral.com/articles/10.1186/s40560-018-0352-2.
Falk L, Hultman J, Broman LM. Extracorporeal Membrane Oxygenation for Septic Shock. Crit Care Med. 2019 Aug;47(8):1097.