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