Gujarat’s 1st Successful Maternal ECMO Case
ECMO SUCCESS STORY
33 Years Female patient With 36 weeks of pregnancy in case of 3rd Gravida with Previous History of LSCS Presented with mildly elevated Liver enzymes with Low lying placenta with ?Adherence with Normal Coagulation profile, Patient Was taken in LSCS explaining High risk Post Partum care. Intra op During LSCS patient got Heavy blood loss due to muscle Rigidity, placental location and severly Plastered abdomen; patient was transfused 3 units PCV and Converted to General Anaesthesia & started on ionotropic support. After satisfactory haemostasis and closure, patient was shifted to ICU with higher Ionotropic support and Mechanical ventilatory support.
33 Years Female patient With 36 weeks of pregnancy in case of 3rd Gravida with Previous History of LSCS Presented with mildly elevated Liver enzymes with Low lying placenta with ?Adherence with Normal Coagulation profile, Patient Was taken in LSCS explaining High risk Post Partum care. Intra op During LSCS patient got Heavy blood loss due to muscle Rigidity, placental location and severly Plastered abdomen; patient was transfused 3 units PCV and Converted to General Anaesthesia & started on ionotropic support. After satisfactory haemostasis and closure, patient was shifted to ICU with higher Ionotropic support and Mechanical ventilatory support.
After Surgery immediately After 3-4 Hours Patient was remaining Hyperthermic with fever spikes of above 102 F Ranging to 106 F With tachycardia up to 170-180 bpm. Cardiologist was involved to see the status of Heart revealing LVEF came down to 20-25% with Global Hypokinesia ,for the same Necessary treatment was staretd. On Day 4 of intensive Care patient’s Lactates started rising above 20 and Became Anuric with persistant High Grade fever with LVEF reduced to less than 15-20% with (?Cytokine storm and Macrophage Activation Syndrome with ? Muscle Damage)(elevated CK aand LDH) , To rescue the perfusion the Call for VA ECMO was taken immediately and It was started along with Hemoperfusion with SLED (Sustained low efficiency dialysis ).
At the time of initiation patient had acute liver injury with liver enzymes elevated to >10000 with Cytokine Storm (probably Shock liver syndrome with MAS ). immediately after starting the ECMO patient’s hyperthermia was controlled to normal temperature by extracoropreal therapeutic cooling. And Ionotropes were also weaned off within few hours of ECMO initiation. After 36 Hours patient was maintaining Good Hemodynamics with LVEF improved to 40-45 % ,Metabolic Acidosis also Correced. Thus,With ECMO Patient Responded Promptly.; patient was weaned off ECMO with Surgical Arterial and Venous closure by Vascular surgeon.
Patient was still anuric(Ischemic ATN) with elevated CPK total. Patient was kept on Maintainance dialysis for further renal replacement therapy. Patient was extubated eventually and shifted to ward for further rehablitation. And after 35 days Of total hospital stay patient was sent Home with intact neurology. Eventually she is not requiring haemodialysis now and started pouring Urine.
Diagnosis
Post Partum Cardiomyopathy with acute cardiogenic shock with Metabolic Acidosis with AKI with ?
MAS (Macrophage Activation Syndrome ).
- Genetic study is awaited to ruleout Malignant Hyperthermia due to anaesthetic Drugs (Succinylcholine + isoflurane)
- Even PCT was not significantly High And blood Cultures were Negative, Ruling out possibility of Sepsis
Treating Team
- Dr. Nirav Jetani (Consultant Gynecologist)
- Dr. Jaydeep Hindocha (Consultant Gynecologist)
- Dr. Tejas Patel (Consultant Intensivist)
- Dr. Dhrumit Gohil (Consultant Physician)
- Dr. Hardik Rathwa (Consultant Physician)
- Dr. Ashish Bavishi (infectious Disease Specialist)
- Dr. Divyesh Patel (Hematologist)
- Dr. Himanshu Pathak (Rheumatologist)
- Dr. Heli Mehta (Anesthetist)
- Dr. Akash Sheth (Anesthetist)
- Dr. Rutvij Shah (Vascular Surgeon)
- Dr. Sandip Rathva (Consultant Radiologist)
- Dr. Ashish Bhalodiya ( Consultant Radiologist)
- Dr. Dipen Agrawal (Gastro-Enterologist)
- Dr. Sanket Saraiya (Cardiologist)
- Dr. Miten Patel (Genral Surgeon)
- Dr. Ashwin Patel (General Surgeon)
- Dr. Rajesh Chaudhary (Consultant Pediatrician)
- Dr. Vishal Sardhara (ECMO specialist)
- Dr. Jaydeep Gajera (ECMO TEAM)
- Mr. Vivek Sardhara (ECMO TEAM)
- Dr. Krunal, Dr. Yashika, Dr. Maheen, Dr. Bansi
- Dr. Mitul, Dr. Pruthvi (Medical officers)
- And All Nursing Staffs
This is the first Maternal Case of Gujarat where ECMO and INTENSIVE CARE UNIT has saved life of a young mother keeping the family complete for the new born baby boy.
From the Team of Synergy Multispeciality Hospital, and Naari women’s Hospital, Vadodara
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