Sometimes an ounce of extracorporeal membrane oxygenation prevention is worth a pound of extracorporeal membrane oxygenation cure

Abstract

Emergency aortic valve replacement in the setting of severe aortic valve stenosis and cardiogenic shock carries increased risk of morbidity, including postcardiotomy cardiac failure. 1 Mechanical circulatory support with extracorporeal membrane oxygenation (ECMO) can be a lifesaving therapy for such patients. We report here the management of a patient with severe prosthetic aortic stenosis in cardiogenic shock whom we treated with ECMO therapy to achieve clinical stabilization before urgent aortic valve replacement. CLINICAL SUMMARY A 77-year old woman was admitted with a non–STsegment myocardial infarction, severe prosthetic aortic valve stenosis, and an ejection fraction of 37%. The patient had cardiogenic shock develop and underwent placement of an intra-aortic balloon pump. This resulted in stabilization of her systemic blood pressure; however, acute kidney injury developed, with low urinary output (67 mL over 6 hours) and elevated serum creatinine level (acute increase