Extracorporeal cardiopulmonary resuscitation for cardiogenic shock in a Jehovah's witness.

Abstract

Veno-arterial (V-A) and veno-venous (V-V) extracorporeal membrane oxygenation (ECMO) are frequently employed in the management of cardiopulmonary failure in critically ill patients. Utilization, however, is controversial in the Jehovah's Witness (JW) population as temporary mechanical circulatory support (tMCS) typically is associated with blood loss requiring transfusions. Despite this fact, use of ECMO is still feasible in this population while avoiding blood transfusions and there have been few reported cases in the literature. However, its use as part of cardiopulmonary resuscitation is limited. Multiple strategies have been employed to limit blood loss and maximize endogenous hematopoiesis to assist in maintaining normal physiology while utilizing tMCS. Though these tactics are most useful when applied in the preintervention setting, they are applicable in the emergency setting including extracorporeal cardiopulmonary resuscitation (ECPR). This can be achieved with conscientious cannulation technique and circuit management. Presented here is a case report of the successful use of V-A ECMO in the resuscitation for a JW, avoiding blood product transfusions. The protocol utilized to eliminate the need for blood transfusions is also discussed. This approach adds to the growing body of evidence emphasizing that the use of tMCS as part of bloodless medicine practice is feasible, even in the emergency setting.