Nghe An General Hospital of Friendship saved the life of a patient who had circulatory arrest twice due to cardiogenic shock with complications of multiple organ failure.
(Baonghean.vn) - A patient with two cardiac arrests due to cardiogenic shock complicated by multiple organ failure was saved by Nghe An General Hospital thanks to the ECMO extracorporeal membrane oxygenation technique combined with continuous blood filtration.
On September 25, 2023, the Intensive Care Department, Nghe An General Hospital received patient PTO, born in 1992. The patient was transferred from Nam Dan District Medical Center to a higher level, with a diagnosis of "shock of unknown cause, monitoring for cardiogenic shock with circulatory arrest, severe arrhythmia".
Medical history revealed: The patient had hemorrhoids and was taking oral and topical medications. Symptoms of cardiogenic shock and arrhythmia began a day before, with initial symptoms of fatigue and increasing shortness of breath.
The patient was admitted to Nam Dan District Medical Center in a state of extreme fatigue, pale lips, low blood pressure, rapid, irregular pulse, and little urine. After 15 minutes of admission to Nam Dan District Medical Center, the patient was found to have lost consciousness, stopped breathing, and had a cardiac arrest. Here, the patient was treated for circulatory arrest, intubated, given a ventilator, received a cardiopulmonary resuscitation, had a remote consultation, and was transferred to Nghe An General Hospital.
When the patient arrived at Nghe An General Hospital, he continued to stop circulating for the second time. The hospital's on-duty team performed CPR, and after 10 minutes of CPR, they regained a pulse and blood pressure. However, the patient's condition was still very critical, with severe arrhythmia and severe metabolic acidosis.
The patient was maintained on high-dose vasopressors and transferred to the Intensive Care Unit, Nghe An General Hospital. At this time, the patient's disease progressed severely, with severe ventricular arrhythmia, progressive heart failure, lactate 12.0, very high cardiac enzyme tests, blood pressure dependent on vasopressors, high-dose cardiac support, and complete anuria.
ECMO (Extracorporeal Membrane Oxygenation – ECMO) is a method of using circulation and oxygen exchange outside the body to support vital functions in patients with circulatory failure. With the same operating principle as an artificial heart-lung machine, ECMO will help maintain the patient's life, while creating time for the heart to rest and recover, and continuously filter blood connected to the ECMO system to create kidney replacement therapy to adjust acid-base, control fluid, and filter cytokines.
ECMO is an advanced, modern treatment method that saves the lives of critically ill patients such as cardiogenic shock due to myocarditis, myocardial infarction, arrhythmia, and critical ARDS pneumonia.
Given the serious progression of the disease, with a very high risk of death, the Intensive Care Unit organized a hospital-wide consultation, an online consultation with cardiovascular and resuscitation experts from Bach Mai Hospital. The PTO patient was diagnosed with cardiogenic shock with two circulatory arrests, severe ventricular arrhythmia, myocarditis monitoring, poisoning, multiple organ failure, hemorrhoids, etc. The patient was prescribed ECMO VA, continuous blood filtration.
PTO patients received ECMO VA, continuous blood filtration, mechanical ventilation, vasopressors, antibiotics, blood pressure control, ECMO membrane anticoagulation and blood filtration, electrolyte adjustment, nutrition, albumin replacement, transfusion of red blood cells, platelets, plasma, and daily echocardiographic assessment of cardiac function.
After active and timely intervention, the patient's condition improved well, hemostasis and blood pressure remained stable, and vasopressors and cardiac support were stopped after 3 days. After 8 days of resuscitation treatment, the patient was taken off ECMO VA, continuous blood filtration, and mechanical ventilation. After 1 month of active treatment, the patient's heart and kidney function recovered well, breathing was stable, and he was eligible for discharge.
The success of the case shows the effectiveness of CPR, the timely and effective initial treatment of shock patients at the district level; shows the effectiveness of advanced techniques applied such as ECMO VA in critical cardiogenic shock and continuous blood filtration in patients with multiple organ failure.
It is known that Nghe An General Hospital has saved the lives of many patients thanks to ECMO and continuous blood filtration techniques. Currently, the Hospital has continued to invest in equipment; focused on training, improving the professional qualifications and skills of the medical team, doctors... from there to deploy more advanced techniques, saving the lives of patients with severe cardiogenic shock, multiple organ failure, and complicated severe cases in Nghe An province and the North Central region./.
