Navigating the Complexity of ARDS and Cardiogenic Shock with Veno-Arterial ECMO: A Case Report

Authors

Sanjana Kesireddy, HCA HealthcareFollow
Mohan Sengodan, HCA HealthcareFollow

Files

Division

North Texas

Hospital

Medical City Fort Worth

Specialty

Internal Medicine

Document Type

Poster

Publication Date

2025

Keywords

extracorporeal membrane oxygenation, ECMO, VV ECMO, VA ECMO, Veno-arterial extracorporeal membrane oxygenation, acute respiratory distress syndrome, ARDS, cardiogenic shock

Disciplines

Cardiovascular Diseases | Internal Medicine | Medicine and Health Sciences | Pathological Conditions, Signs and Symptoms | Respiratory Tract Diseases | Therapeutics

Abstract

INTRODUCTION: When deciding between VA ECMO (veno-arterial ECMO) and VV ECMO (veno-venous ECMO), the primary consideration is the underlying pathology affecting the patient’s heart and lungs. VA ECMO provides support for both the cardiovascular and respiratory systems, making it suitable for patients experiencing cardiogenic shock or combined cardiac and respiratory failure. In contrast, VV ECMO is used exclusively for respiratory failure, offering support to patients with severe lung dysfunction but intact cardiac function. CASE PRESENTATION: 41 year old male with no known past medical history presented s/p cardiac arrest secondary to aspiration pneumonia due to alcohol and opioid intoxication. Chest xray demonstrated diffuse bilateral lung opacities. Initial ABG had a pH of 7.1, pCO2 55, pO2 57. Patient underwent emergent bronchoscopy in ED and was found to have large volume of aspirated vomit and foreign debris in bilateral lungs. Due to worsening lactic acid, respiratory status and increasing vasopressor support, VA ECMO was initiated. LEARNING POINTS: This patient had acute hypoxic respiratory failure and Acute Respiratory Distress Syndrome (ARDS) with Cardiogenic shock therefore VA ECMO was started instead of VV ECMO. VA ECMO provides dual support for both the heart and lungs. It addresses the heart's inability to pump blood by providing circulatory support (oxygenated blood is returned to the arterial system), while also assisting the lungs by oxygenating the blood externally, bypassing the damaged lungs. This makes VA ECMO particularly useful when both cardiac and respiratory failure are present.

Original Publisher

HCA Healthcare Graduate Medical Education

Recommended Citation

Kesireddy, Sanjana and Sengodan, Mohan, "Navigating the Complexity of ARDS and Cardiogenic Shock with Veno-Arterial ECMO: A Case Report" (2025). North Texas Research Forum 2025. 14.
https://scholarlycommons.hcahealthcare.com/northtexas2025/14