STRESS AND SHOCK: CASE OF MECHANICAL CIRCULATORY SUPPORT IN TOXIC SHOCK

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Sepsis may induce stress-induced cardiomyopathy by increased catecholamines. Although reversible, In severe cases this lead to ventricular arrhythmias, thromboembolism, and cardiogenic shock. There is hospital mortality with age >80, black race, presence of multi organ failure. CASE PRESENTATION: 52 yo male unknown medical history presents belligerent behavior shortness breath. He was noted be febrile 108F, hypotensive MAPs in the 40s, tachycardic 140s, hypoxic 79% on room air. Labs significant for WBC 1, Cr 4.2, lactic acid 11.7, CK 2407, Troponin 0.104. ABG showed pH 7.19, pCO2 54, pO2 48, FiO2 100%. Chest xray bilateral interstitial airspace opacities. Patient intubated hypercapnic respiratory failure started norepinephrine, vasopressin, epinephrine 5L fluid bolus stress dose steroids. TTE demonstrated left ventricle apical mid wall segment akinesis ballooning. VA-ECMO emergently initiated ARDS management Impella placed shock secondary sepsis-induced Takotsubo cardiomyopathy. Sputum cultures returned positive MRSA Streptococcus pyogenes. Antibiotics changed vancomycin, zosyn, azithromycin, cefepime, clindamycin account toxic Hospital course complicated development pancytopenia requiring use granix, atrial fibrillation rapid rate emergent cardioversion, renal CRRT. removed sixth day patient dobutamine. eventually developed critical limb ischemia all four extremities need hand hip disarticulations. On ninth day, transitioned comfort care passed away. DISCUSSION: case above, septic caused that required Impella. adult population, has not been widely used treatment refractory outcomes VV-ECMO have better than VA-ECMO. This likely due VA-ECMO's profound hypoperfusion higher incidence neurological complications, failure, ischemia. The addition helps unload EMCO weaning. CONCLUSIONS: Studies found were associated door-to-ECMO times ≤96 hours, Gram-positive sepsis, pneumonia rather primary bloodstream infections. Though our met these criteria, his still resulted poor outcomes. REFERENCE #1: Cheng A, Sun HY, Tsai MS, Ko WJ, PR, Hu FC, Chen YC, Chang SC. Predictors survival adults undergoing extracorporeal membrane oxygenation Journal thoracic cardiovascular surgery. 2016 Dec 1;152(6):1526-36. #2: Nabzdyk CS, Couture EJ, Shelton K, Cudemus G, Bittner EA. induced cardiomyopathy: Pathophysiology mechanical circulatory support care. 2019 1;54:228-34. #3: Schmitz, M., Roux, X., Huttner, B. et al. Streptococcal syndrome intensive unit. Ann. Intensive 8, 88 (2018). https://doi.org/10.1186/s13613-018-0438-y DISCLOSURES: No relevant relationships Debapria Das, source=Web Response Abigail Go, Daniele Valentini,