Successful treatment of near-fatal pulmonary embolism and cardiac arrest in an adult patient with fulminant psittacosis-induced severe acute respiratory distress syndrome after veno-venous extracorporeal membrane oxygenation rescue: A case report and follow-up

作者：Song-Liu Yang, Yang Gao, Zhiyang Han, Xue Du, Wen Liu, Songgen Jin, Ying Bi, Peng-Fei Chen, Chuang-Shi Yue, Ji-Han Wu, Qi-qi Lai, Yujia Tang, Xin-Tong Wang, Yuanyuan Ji, Mingyan Zhao, Kai Kang, Kaijiang Yu · 发表于：Heliyon · 年份：2023 · DOI：10.1016/j.heliyon.2023.e20562 · 被引用次数：7 · 研究领域：Mechanical Circulatory Support Devices、Heparin-Induced Thrombocytopenia and Thrombosis、Venous Thromboembolism Diagnosis and Management

Background Veno-venous extracorporeal membrane oxygenation (ECMO) was successfully performed for the rescue of an adult patient with severe acute respiratory distress syndrome (ARDS) induced by fulminant psittacosis, and then a near-fatal pulmonary embolism (PE) and cardiac arrest (CA) of the same patient was cured through catheter-directed thrombolysis. Case presentation A 51-year-old female patient was admitted to the hospital on September 10, 2021 due to slurred speech, weakness in lower limbs, dizziness, and nausea. Subsequently, she developed confusion and was transferred to the intensive care unit (ICU), where she received anti-shock, antibiotics, invasive mechanical ventilation (IMV), and veno-venous ECMO due to the diagnosis of severe pneumonia, severe ARDS, and septic shock based on comprehensive physical examination, laboratory tests, and imaging findings. The metagenomic next-gengeration sequencing ( m -NGS) in the bronchoalveolar lavage fluid (BALF) suggested that the pathogen was chlamydia psittaci, so the antibiotics were adjusted to doxycycline combined with azithromycin. After withdrawal from ECMO, ultrasound (US) re-examination of the left lower limb revealed inter-muscular vein thrombosis, following which heparin was replaced by subcutaneous injection of 0.4ml enoxaparin sodium twice daily for anti-coagulation therapy. After withdrawal from IMV, the patient suffered sudden CA and successful cardiopulmonary resuscitation (CPR), and emergency pulmonary angiogr...