A Case of <i>Vibrio vulnificus</i> Sepsis: A Potential Use of Extracorporeal Membrane Oxygenation

Park, Sun-Young; Nam, Hyunseung; Park, Sunghoon; Park, Jae Yong; Ha, Sang Ook; Lee, Sun Hee; Kim, Hyoung Soo

J Korean Soc Emerg Med > Volume 28(1); 2017 > Article

Case Report

Journal of The Korean Society of Emergency Medicine 2017;28(1): 133-137.

A Case of Vibrio vulnificus Sepsis: A Potential Use of Extracorporeal Membrane Oxygenation

Sun-Young Park¹, Hyunseung Nam¹, Sunghoon Park², Jae Yong Park³, Sang Ook Ha⁴, Sun Hee Lee⁵, Hyoung Soo Kim⁵

¹Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
²Division of Pulmonary, Allergy and Critical Care Medicine, Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
³Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, Anyang, Korea
⁴Department of Emergency Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
⁵Department of Cardiothoracic Surgery, Hallym University Sacred Heart Hospital, Anyang, Korea

Correspondence

Hyoung Soo Kim ,Tel: 031-380-3815, Fax: 031-380-3973, Email: cskhs99@hallym.or.kr ,

Received: October 2, 2016; Revised: October 6, 2016 Accepted: November 1, 2016. Published online: February 28, 2017.

ABSTRACT

Necrotizing fasciitis caused by Vibrio vulnificus can rapidly progress to septic shock and death. Hence, early surgical debridement of the involved tissue is vital. However, this can be a challenging task due to the coagulopathy and unstable conditions often associated with these patients. Herein, we present a patient with necrotizing fasciitis caused by V. vulnificus who received extracorporeal membrane oxygenation (ECMO) support for refractory hypotension. After initiating ECMO, his vital signs stabilized, and lactate, C-reactive protein, and procalcitonin levels continued to decrease. He underwent several rounds of surgical debridement and vacuum-assisted drainage on both lower legs. On ECMO day 15, he was successfully weaned off the device and his condition was uneventful for several days. However, on the 24th day of intensive care unit (ICU), he was again placed on ECMO due to clinical deterioration. On ICU day 32, he underwent bilateral below-knee amputations due to delayed wound healing. Unfortunately, he subsequently developed multi-organ failure and died. Nonetheless, this case is instructive regarding the potential use of ECMO. We suggest that ECMO could provide the necessary time for sepsis patients to undergo aggressive medical and surgical interventions.

Key words: Extracorporeal membrane oxygenation, Fasciitis, necrotizing, Sepsis, Vibrio vulnificus