In sepsis-induced heart failure, extracorporeal membrane oxygenation can provide support

Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection. 1 Singer M Deutschman CS Seymour CW et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016; 315: 801-810 Crossref PubMed Scopus (9489) Google Scholar Septic shock occurs when serum lactate is elevated and vasopressor medication is required despite adequate fluid resuscitation. 2 Cecconi M Evans L Levy M Rhodes A Sepsis and septic shock. Lancet. 2018; 392: 75-87 Summary Full Text Full Text PDF PubMed Scopus (467) Google Scholar Many cardiovascular features of septic shock exist, including tachycardia, alterations in vascular tone, and reduced ventricular function. Haemodynamic patterns differ with age, characteristically manifesting as pulmonary hypertension and right heart failure in newborn infants, left heart failure in young children, and distributive shock in adolescents and adults. 3 Davis AL Carcillo JA Aneja RK et al. American College of Critical Care Medicine clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock. Crit Care Med. 2017; 45: 1061-1093 Crossref PubMed Scopus (277) Google Scholar However, this cannot be predicted by age alone and might change as the disease progresses. One particularly troubling manifestation of sepsis is severe heart failure with refractory shock, which accounts for half of sepsis-related deaths in children within the first 24 h of hospital admission. 4 Weiss SL Peters MJ Alhazzani W et al. Surviving Sepsis Campaign International Guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. Pediatr Crit Care Med. 2020; 21: e52-e106 Crossref PubMed Scopus (202) Google Scholar , 5 Schlapbach LJ MacLaren G Festa M et al. Prediction of pediatric sepsis mortality within 1h of intensive care admission. Intensive Care Med. 2017; 43: 1085-1096 Crossref PubMed Scopus (75) Google Scholar , 6 Cvetkovic M Lutman D Ramnarayan P Pathan N Inwald DP Peters MJ Timing of death in children referred for intensive care with severe sepsis: implications for interventional studies. Pediatr Crit Care Med. 2015; 16: 410-417 Crossref PubMed Scopus (47) Google Scholar Severe heart failure can also occur in adult patients, albeit less commonly. In The Lancet, Nicolas Bréchot and colleagues present the results of a study examining the use of extracorporeal membrane oxygenation (ECMO) for sepsis-induced cardiogenic shock. 7 Bréchot N Hajage D Kimmoun A et al. Venoarterial extracorporeal membrane oxygenation to rescue sepsis-induced cardiogenic shock: a retrospective, multicentre, international cohort study. Lancet. 2020; 396: 545-552 Summary Full Text Full Text PDF PubMed Scopus (30) Google Scholar Venoarterial extracorporeal membrane oxygenation to rescue sepsis-induced cardiogenic shock: a retrospective, multicentre, international cohort studyPatients with severe sepsis-induced cardiogenic shock treated with VA-ECMO had a large and significant improvement in survival compared with controls not receiving ECMO. However, despite the careful propensity-weighted analysis, we cannot rule out unmeasured confounders. Full-Text PDF