A Real Circuit Breaker: Hyperhemolysis Syndrome Related to the VA-ECMO Circuit?

IntroductionMyocarditis is an inflammatory disease of cardiac muscle caused by a variety infectious and non-infectious conditions. Viral infection the most frequent cause myocarditis; however, herpes simplex virus 1 (HSV-1) causing myocarditis has been rarely described. We present case young woman with HSV-1 viremia fulminant presenting cardiogenic shock requiring venoarterial extracorporeal membrane oxygenation (VA-ECMO), complicated hyperhemolysis.Case ReportA 35 year-old immunocompetent moderate alcohol consumption presented to hospital 4-day history fever flu-like symptoms. She was fully vaccinated for COVID-19 two months prior symptom onset. Her testing negative she discharged home. returned 4 days later in shock. Transthoracic echocardiogram demonstrated LVEF 30% small pericardial effusion. Coronary angiogram revealed normal coronaries. placed on peripheral VA-ECMO worsening Due inadequate LV unloading, underwent atrial septostomy. Five after cannulation, detected blood started intravenous acyclovir. ECMO course acute kidney injury dialysis, hyperhemolysis peak LDH 12,000 U/L. The mechanism hemolysis attributed intravascular process (plasma free hemoglobin 7487 mg/L, < 150 mg/L) likely from combination cold agglutinins mechanical circuit. Interestingly pressure gradient within normal. patient received treatment plasmapheresis (Table 1), eventually decannulated 12 following hemodynamic improvement.SummaryThis report highlights rare viral emphasizes need collaboration among various specialists management complex cases. Myocarditis hyperhemolysis. A improvement. This