Veno-Arterial Extracorporeal Membrane Oxygenation for Cardiogenic Shock in a Jehovah's Witness Patient

Abstract

Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) may support hemodynamics of patients experiencing cardiogenic shock refractory to medical management. We present a 62-year-old Jehovah's Witness female with a history of smoking, obstructive sleep apnea, and anemia presenting with acute myocardial infarction and ensuing cardiogenic shock that required V-A ECMO support due to persistent hemodynamic instability and hypoxemia. Meticulous care to blood saving strategies were employed contributing to the successful management of the patient. These strategies included minimizing frequency of laboratory testing, use of micro-pediatric tubes, meticulous tissue handling to minimize blood loss during decannulation and administration of supplementary agents (vitamin B12, folic acid, iron, and erythropoietin) in consideration with the ethical concerns of the patients and their family. During the patient's hospital stay, their hemoglobin decreased from 14.6 mg/dL to as low as 7.6 mg/dL 3 days after decannulation. To our knowledge, this is the third reported case of V-A ECMO support in a Jehovah's Witness patient and the first reported critical care case. In conclusion, employing a bloodless strategy and adhering to recommended practices can yield positive outcomes for patients who do not accept blood transfusions requiring V-A ECMO.