Veno-venous ECMO and septic shock in newborns. Case report

Background Neonatal septic shock due to streptococcal infection remains a l ife threatening disease. Veno-arterial ECMO represents a potentially lifesa ving therapy even after all other measures have failed. Case report. 2 hours after uncomplicated delivery a mature neonate experien ced severe pulmonary and circulatory failure with pulmonary hemorrhage. Des pite intensive care with artificial ventilation, inotropes, volume support and antiinfecitve therapy further deterioration occured. Echocardiography r evealed myocardial failure and pulmonary hypertension. Pulmonary hypertensi on decreased after supplementary ventilation with nitric oxide was started, but the child deteriorated hemodynamically. Since conventional medical man agement was not successful,a modified single-needle venovenous ECMO was ins talled. Immediately after starting ECMO, pulmonary and circulatory function improved, and the child survived without permanent damage despite a proven streptococci infection. Discussion. A single-needle veno-venous ECMO used during neonatal septic sh ock despite marked hemodynamic compromise, resulted in a prompt increase in oxygenation, reduced the pulmoarterial resistance and thereby normalized t he hemodynamic situation. The pulsatile perfusion of the system remaind sta ble.