Is ECMO required for ARDS with multi-organ failure?

Question

Hello doctor,

A patient transferred from a rural clinic with ARDS and multi-organ failure. It looks like a scrub typhus. I started Doxycycline but it is getting worse. The patient is on triple pressors. Should we consider ECMO?

Please suggest.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

This patient has severe scrub typhus with ARDS (acute respiratory distress syndrome) and multi-organ failure, requiring mechanical ventilation and high-dose vasopressor support.

Treatment plan:

Doxycycline is the correct first-line treatment, but if the patient is worsening, consider adding Azithromycin or Chloramphenicol. Look for secondary infections contributing to worsening sepsis.
Survival in ECMO (extracorporeal membrane oxygenation) for sepsis plus ARDS is variable, and outcomes depend on the reversibility of the infection and organ support needed. This patient is on triple pressors, suggesting refractory shock, possibly requiring VA-ECMO (venoarterial extracorporeal membrane oxygenation), which is a higher risk. But if there is severe DIC (disseminated intravascular coagulation), uncontrolled bleeding, or irreversible multi-organ failure present, then ECMO may not be beneficial.
ECMO is an option, but only if the infection is being adequately treated and there is a realistic chance of organ recovery. If multi-organ failure is irreversible, ECMO may not improve survival.
If other things are under control and only refractory hypoxemia or shock persists despite maximum support, then ECMO might help.

I hope this has helped you.

Please feel free to reach me again, in case of further queries.

Thank you.