Successful treatment of severe acute respiratory distress syndrome due to Group A streptococcus induced toxic shock syndrome in the third trimester of pregnancy‐effectiveness of venoarterial extracorporeal membrane oxygenation: A case report

Abstract

We report a case of Group A streptococcal infection‐induced toxic shock syndrome (GAS‐TSS) with severe acute respiratory distress syndrome (ARDS), successfully treated with venoarterial extracorporeal membrane oxygenation (V‐A ECMO). A 31‐year‐old woman was transferred due to high fever, continuous uterine contractions and fetal bradycardia at 31 weeks of gestation. She was in a shock status on arrival, and as fetal heart beat disappeared, we canceled the cesarean section and took priority in maternal rescue. At 21 h after the admission, pulseless ventricular tachycardia occurred, and V‐A ECMO was introduced after defibrillation, which dramatically improved her respiratory and circulatory conditions. On the 3rd day, GAS was isolated from blood culture. The patient was freed from V‐A ECMO on the 5th day and was discharged on the 25th day without permanent impairment. V‐A ECMO should be considered as an effective therapeutic option against ARDS and circulation failure in GAS‐TSS during pregnancy.

Venoarterial extracorporeal membrane oxygenation for group B streptococcal toxic shock syndrome: A case report and literature review

“…A total of 7 case reports describing 8 patients [7–13] and 1 retrospective observational study describing 10 patients [15] were identified. In addition, 1 case report was manually searched.…”

“…The rapid progression of circulatory failure owing to STSS leads to refractory shock and finally CPA. Recently, some case reports have demonstrated the effectiveness of VA-ECMO in saving the lives of such patients [7][8][9][10][11][12][13] ; however, its efficacy remains unknown. Therefore, we collected case reports on VA-ECMO for adult patients with STSS and investigated its characteristics and outcomes.…”

“…In recent years, several case reports on adult patients with STSS who were introduced to venoarterial extracorporeal membrane oxygenation (VA-ECMO) have been published. [7][8][9][10][11][12][13] However, the effectiveness of VA-ECMO for septic shock in adults is controversial. [14][15][16][17] In patients aged 60 years or older, [14] distributive shock with normal cardiac function [17] and CPA before ECMO initiation [18] have been reported as poor prognostic factors of ECMO therapy for septic shock.…”

Extracorporeal membrane oxygenation in pregnant and postpartum women: a ten-year case series

“… 30 In addition, other single case reports of ECMO in pregnancy were published, the vast majority of which reported successful outcomes. 7 , 8 , 9 , 10 , 11 , 12 The wide range of outcomes in previous reports may reflect differences in patient-level factors and specific underlying etiologies of ARDS, in addition to publication biases. We posit that the differences we found in maternal outcomes in our cohort of women who received ECMO may reflect the unbiased reporting of all cases at our institution.…”

“…The largest case series we are aware of consists of 18 women (4 pregnant and 14 postpartum) 6 ; many publications are single case reports. 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 Although the ELSO closely monitors outcomes and complication rates among individuals receiving ECMO, they do not track pregnancy or postpartum status. 1 Therefore, the purpose of this study is to add to the literature by providing additional cases of ECMO use in obstetric patients to further support claims of safety and efficacy when used in pregnant and postpartum women.…”