We describe the case of fulminant myocarditis due to Lyme disease and use of mechanical circulatory support (MCS) for the treatment of the Lyme carditis associated with refractory cardiogenic shock. Fulminant Lyme myocarditis in young adult male patient led to a sudden onset of acute, severe biventricular heart failure with progressive cardiogenic shock, and multiorgan failure immediately after admission.The previously healthy 28-year-old man was admitted to hospital with dyspnea, atrial flutter with 160/min ventricles rate, normotension, cardiomegaly, and incipient cardiogenic pulmonary edema on chest x-ray. Within the next 24 hours, the acute heart failure (AHF) progressed to the refractory cardiogenic shock with severe systemic hypotension, respiratory distress, anuria, liver congestion, and laboratory evidence of extremely high level of the anaerobic metabolism in the arterial blood (pH 7.16; HCO3 12.3 mmol/L; BE -14.6; lactates level 17 mmol/L). The transesophageal echo imaging showed severe dilatation and global biventricular akinesis, with left ventricular ejection fraction of 5%. The diagnosis of acute fulminant myocarditis of unknown etiology was reached. Since the patient did not respond rapidly to vasoactive and supportive therapy, MCS was immediately inserted. Broad differential diagnosis of fulminant myocarditis was considered and disseminated Borrelia infection was serologically confirmed and appropriate antimicrobial therapy was started from the fifth day after admission. MCS used over the next 26 days was successfully integrated with pharmacologic support and artificial ventilation in therapy. The patient was discharged from hospital after 65 days with a complete restoration of bilateral heart ejection fraction.This case shows that the clinical course of the Lyme carditis can present uncommonly with profound cardiovascular collapse and the MSC implementation should be considered in the early stage of drug resistant hemodynamic instability. Rapid transfer to the cardiac center where the MCS is available for all patients with signs and symptoms of AHF due to confirmed or suspected Lyme carditis would be recommended, as this treatment could be the only life-saving method.

The aim of this case report is to present the life saving use of extracorporeal membrane oxygenation (ECMO) in an obstetric patient with acute cardiorespiratory collapse following massive bleeding caused by an atonic uterus post partum. A 39-year-old patient, following a spontaneous abortion at 21 weeks of pregnancy, developed uterine atony and massive bleeding and was ultimately referred to the operating room for an emergent hysterectomy. Postoperatively, she was referred to the intensive care unit (ICU) where she developed severe acute respiratory distress syndrome (ARDS) that was successfully treated by employing ECMO. Following discontinuation of ECMO, her treatment was further complicated by a manifest hemolytic transfusion reaction. Although extensive testing was done to establish the cause of this reaction, we were unable to find it. The patient responded well to treatment with erythropoietin (EPO) and corticosteroids as well as a restrictive transfusion regime. This treatment pointed to a possible immune reaction to massive transfusions of blood products. This case demonstrated the importance of early aggressive treatment using ECMO in reversal of life threatening ARDS, as well as the need for a judicious approach when transfusing blood products.

Cilj: Veno-arterijska izvantjelesna membranska oksigenacija (engl. veno-arterial extracorporeal membrane oxygenation; VA-ECMO) metoda je pružanja potpore funkciji srca u pacijenata s kardiogenim šokom kod kojih medikamentozna terapija nije dovoljna. Cilj rada je ukazati, kroz prikaz liječenja pacijenta koji je u ranom poslijeoperacijskom tijeku po transplantaciji bubrega razvio kardiogeni šok, na veliki potencijal primjene izvantjelesne mehaničke potpore radu srca kao metode liječenja kardiogenog šoka u ovih pacijenata, koja je, u opisanom tijeku liječenja, omogućila ne samo preživljavanje pacijenta, već i očuvanje funkcije transplantata. Prikaz slučaja: Na Odjel intenzivnog liječenja (OIL) primljen je šezdesetjednogodišnji pacijent sa završnim stadijem kronične bubrežne bolesti, kojem je učinjena transplantacija bubrega. Tijek operacijskog zahvata komplicirao se razvojem značajne hemodinamske nestabilnosti. Pacijent je, usprkos svim poduzetim medikamentoznim mjerama liječenja, razvio infarkt miokarda s kardiogenim šokom. S obzirom na to da je stanje bilo refraktorno na primijenjenu medikamentoznu terapiju, donesena je odluka o primjeni izvantjelesne mehaničke potpore cirkulaciji. Mehanička potpora dovela je do hemodinamske stabilizacije pacijenta i poslužila je kao most do oporavka srčane funkcije s uspješnim očuvanjem funkcije transplantata. Zaključci: U rastućem broju radova mehanička cirkulatorna potpora je označena kao budućnost liječenja kardiogenog šoka, neovisno o njegovoj etiologiji. Kao i sve druge metode liječenja, nosi rizik od razvoja komplikacija, koji se razvojem tehnologije polako smanjuje. Ona postaje sve dostupnija te se njezina primjena širi na različite skupine pacijenata. Važno je naglasiti da je za uspjeh terapije nužna suradnja specijalista različitih specijalnosti u liječenju ovako kompleksnih pacijenata.