Veno-Arterial Extracorporeal Membrane Oxygenation for Electrical Injury Induced Cardiogenic Shock Support: A Case Report

Abstract BackgroundHigh voltage electrical injury (HVEI) of more than 1,000V is a potentially devastating form of a multisystem injury associated with high morbidity and mortality. We present the first case of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) as a life saving device for treating a patient with severe cardiogenic shock after a high voltage electrical injury.Case Presentation A 26-year-old male sustained HVEI while working with a concrete mixer pump that came in contact with a high voltage cable of 10,000 volts. He was immediately disconnected from the mixer pump, underwent cardiopulmonary resuscitation and transported to the nearest medical centre with severe cardiogenic shock with ejection fraction (EF) < 10%. Upon arrival he was in critical condition, sedated and mechanically ventilated, haemodynamically unstable and supported by intravenous (IV) inotropes after a few events of ventricular fibrillation, with an electrical entry point on the left hand and an exit point in his right leg. Blood pH was 6.8, PCO2 53 mmHg, PaO2 of 57 mmHg, lactate 8 mmol/L, and Troponin 38000 ng/dl. EF was 10% with a global severe left ventricular dysfunction. During cardiopulmonary resuscitation (CPR) including cardiac massage and few electrical shocks he was immediately connected to the VA-ECMO via open right femoral approach with distal arterial leg perfusion.He was treated with IV broad spectrum antibiotics, and high volume fluids to prevent rhabdomyolysis-induced acute kidney injury, total parenteral nutrition, topical silver sulfadiazine cream, and Granuflex for severe electrical burns. He was gradually weaned from inotropes over the next 3 days, during which his clinical condition and bloodwork improved tremendously. His EF gradually increased to 50% and he was weaned from the VA-ECMO and underwent decannulation 86 hours after initialization. He was discharged on day 27 without any sequelae.Conclusion VA-ECMO treatment can be a lifesaving device for treating severe cardiogenic shock caused by high voltage electrical injury, and should be considered while treating these “high-mortality risk” patients.