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A 60-year-old man was diagnosed with severe sepsis caused by pyelonephritis. During transfer to the hospital room, he suddenly developed ventricular fibrillation and the patient recovered after electrical defibrillation. After this cardiac event, his haemodynamics collapsed despite administration of crystalloid fluid. Transthoracic echocardiography was immediately performed showing the oedema and reduced left ventricular wall motion. Since the haemodynamic collapse was too severe to maintain with conventional septic shock therapy, we introduced extracorporeal cardiopulmonary resuscitation, bridging to administration of antibiotics. As a result of these combined therapies, the patient was successfully resuscitated. From this clinical course, we finally diagnosed that the severe sepsis was concomitant with myocardial depression. Introduction of mechanical support, including extracorporeal cardiopulmonary resuscitation may be recommendable in cases of severe sepsis with myocardial depression resulting in haemodynamic collapse, however, the option of introduction of an invasive approach needs further examination.

bmj case reports

Myocardial depression induced by severe sepsis: successful rescue using extracorporeal cardiopulmonary resuscitation from initial phase of severe sepsis