mrsa sepsis and ards; is it an indication for ecmo? philip hsiao bs, joseph miessau ms, harrison...

MRSA sepsis and ARDS; Is it an indication for ECMO?

Philip Hsiao BS, Joseph Miessau MS, Harrison Pitcher MD, Qiong Yang MD, Michael Baram MD, Nicholas Cavarocchi MD,

Hitoshi Hirose MD,PhD.Thomas Jefferson University, Philadelphia, PA

Presentation• 39 yo African American Female presents with respiratory

distress 2 days after ECRP for pancreatitis.• Patient quickly deteriorates, required intubation and

developed severe hypotension requiring vasopressors.Pre Ecmo ABG: pH 7.01, PaCO2 70, PaO2 70

with Fi02 100% with PEEP 15• Preliminary results of cultures were negative at ECMO

placement.• VA-ECMO started for ARDS and SIRS due to ongoing

pancreatitis.

Intervention/Results• Subsequent blood/sputum cultures came back positive for

MRSA, and persisted despite appropriate antibiotic coverage• CXR and CT chest worsened with formation of multiple

pulmonary cavitary like lesions

Results• On POD#3, patient was found comatose and cerebral

oximetry dropped from baseline 20% bilaterally• Emergent CT scan of head showed bilateral embolic strokes in

occipital and temporal regions

Results/Conclusions• Post mortem autopsy showed multiple pancreatic and lung

abscesses.

• This case illustrates that MRSA bacteremia is a major contraindication for the use of ECMO. Cerebral oximetry was useful for detection of major stroke.