Veno-arterial extracorporeal membrane oxygenation in a patient with septic cardiomyopathy induced by severe community-acquired pneumonia due to Acinetobacter baumannii: A case report.

rationaleCommunity-acquired pneumonia due to Acinetobacter baumannii (CAP-AB) is uncommon; however, its mortality is extremely high because of severe pneumonia, septic shock, and multiple organ dysfunction syndrome including septic cardiomyopathy and cardiogenic shock. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO), an important component of treatment in the early stage of septic cardiomyopathy can affect the prognosis of similar patients. PATIENT CONCERNS: A 65-year-old man presented to the fever clinic with fever, cough, and stuffiness for 1 day. On admission, he manifested hypoxemia and hypotension, and chest computed tomography showed pneumonia, and Acinetobacter baumannii (AB) was positive in bronchoalveolar lavage fluid tested by metagenomic next-generation sequencing (mNGS). DIAGNOSES: Community-acquired pneumonia (CAP), respiratory failure, septic shock, septic cardiomyopathy, and cardiogenic shock.

interventionsAs the diagnosis of septic shock, septic cardiomyopathy and cardiogenic shock induced by CAP-AB and respiratory failure were made, cefoperazone/sulbactam 3 g q8h, moxifloxacin 400 mg qd, inotropes and vasopressors and mechanical ventilation were initiated. However, although global end diastolic volume index was 744 mL/m2, hypotension and tachycardia remained, the left ventricular ejection fraction was 30%, and circulatory failure (cardiogenic shock) did not improve. Hence, VA-ECMO was applied to assist circulation on the day of admission due to the involvement of septic cardiomyopathy and cardiogenic shock. OUTCOMES: On day 2, tachycardia improved, left ventricular ejection fraction increased to 54%, and VA-ECMO was withdrawn on day 5. On day 10, mechanical ventilation was withdrawn and the tracheal cannula was removed. Subsequently, the patient was transferred to the respiratory department on day 14. LESSONS: A patient with septic cardiomyopathy and cardiogenic shock induced by severe CAP-AB was treated with VA-ECMO in the early stage. Patients with CAP-induced septic cardiomyopathy may benefit from the introduction of VA-ECMO during the early stage. Further studies are required to evaluate the advantages and disadvantages of early VA-ECMO in patients with CAP-induced septic cardiomyopathy.