Bedside emergency surgical decompression and venoarterial extra‐corporeal membrane oxygenation for obstructive uropathy with uroseptic cardiomyopathy‐induced arrest: A case report

Abstract

Background: Septic shock combined with septic cardiomyopathy greatly increases the risk of mortality in elderly patients. Patients with a rapid deteriorating state unresponsive to standard resuscitation may benefit from extra‐corporeal membrane oxygenation (ECMO). In cases where obstructive uropathies lead to urosepsis, emergent decompression with double‐J (D‐J) stenting may be necessitated.

Case Presentation: We report the case of a 72‐year‐old woman who arrived at the emergency department and rapidly deteriorated into a state of shock. During the process of resuscitation, emergent biochemical and ultrasound results suggested septicemia and septic cardiomyopathy due to urinary tract infection caused by ureteric stone obstruction. She was transferred to the intensive care unit to be put on venoarterial ECMO after failed resuscitation. Given the suspected diagnosis, it was decided that an emergent bedside digital disposable flexible ureteroscopy (ddFURS) and D‐J catheterization to be performed as rescue decompression procedure. The patient was successfully stabilized with received antibiotic and continuous renal replacement therapy (CRRT) before being transferred to the cardiology department to correct her arrhythmia. She was weaned off CRRT and was able to walk without the need of aids upon discharge.

Conclusion: Uroseptic cardiomyopathy can rapidly progress to renal and cardiac failure. Emergent decompression with ddFURS and D‐J stenting can be performed effectively even in a patient with venoarterial ECMO for rescuing uroseptic cardiomyopathy‐induced arrest secondary to obstructive uropathy. Short‐term outcomes were favorable. However, long‐term prognosis remains to be elucidated.

Keywords

case report / extracorporeal membrane oxygenation / septic cardiomyopathy / urosepsis / urological surgery

References

[1] L'Heureux M , Sternberg M , Brath L , Turlington J , Kashiouris MG . Sepsis-induced cardiomyopathy: a comprehensive review. Curr Cardiol Rep. 2020; 22 (5): 35.

[2] Bailly B , Lecheneaut M , Gbaguidi-Haore H , Chirouze C , Kleinclauss F , Bouiller K . Epidemiology and risk factors for febrile ureteral stent-associated urinary tract infections: a prospective observational cohort study. J Infect. 2023; 87 (1): 12- 7.

[3] Mahapatra S , Heffner AC . Septic shock. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2024. Available from NCBI website (books/NBK430939/).

[4] Hardie EM , Kyles AE . Management of ureteral obstruction. Vet Clin N Am Small Anim Pract. 2004; 34 (4): 989- 1010.

[5] Bonkat G , Cai T , Veeratterapillay R , Bruyère F , Bartoletti R , Pilatz A , et al. Management of urosepsis in 2018. Eur Urol Focus. 2019; 5 (1): 5- 9.

[6] Grasso C , Annich GM . Venoarterial extracorporeal membrane oxygenation in severe pediatric septic shock. Pediatric Crit Care Med. 2018; 19 (10): 1000- 999.

[7] Baek MS , Lee SM , Chung CR , Cho WH , Cho YJ , Park S , et al. Improvement in the survival rates of extracorporeal membrane oxygenation-supported respiratory failure patients: a multicenter retrospective study in Korean patients. Crit Care. 2019; 23: 1.

[8] Hollenberg SM , Singer M . Pathophysiology of sepsis-induced cardiomyopathy. Nat Rev Cardiol. 2021; 18 (6): 424- 34.

[9] Lin YM , Lee MC , Toh HS , Chang WT , Chen SY , Kuo FH , et al. Association of sepsis-induced cardiomyopathy and mortality: a systematic review and meta-analysis. Ann Intensive Care. 2022; 12 (1): 112.

[10] Boissier F , Aissaoui N . Septic cardiomyopathy: diagnosis and management. J Intensive Med. 2022; 2 (1): 8- 16.

[11] Falk L , Hultman J , Broman LM . Extracorporeal membrane oxygenation for septic shock. Crit Care Med. 2019; 47 (8): 1097- 105.

[12] Eleuteri K , Koerner MM , Horstmanshof D , El Banayosy A . Temporary circulatory support and extracorporeal membrane oxygenation. Cardiol Clin. 2018; 36 (4): 473- 85.

[13] Danial P , Olivier ME , Bréchot N , Ponnaiah M , Schoell T , D'Alessandro C , et al. Association between shock etiology and 5-year outcomes after venoarterial extracorporeal membrane oxygenation. J Am Coll Cardiol. 2023; 81 (9): 897- 909.

[14] Oliver WC . Anticoagulation and coagulation management for ECMO. Semin Cardiothorac Vasc Anesth. 2009; 13 (3): 154- 75.

[15] Mazzeffi MA , Rao VK , Dodd-O J , Del Rio JM , Hernandez A , Chung M , et al. Intraoperative management of adult patients on extracorporeal membrane oxygenation: an expert consensus statement from the society of cardiovascular anesthesiologists-part ii, intraoperative management and troubleshooting. Anesth Analg. 2021; 133 (6): 1478- 93.

[16] Bres-Niewada E . Ureteral obstruction in pregnancy—The “Stone Mountain” for the Urologist. Cent Eur J Urol. 2017; 70 (1): 101- 2.

[17] Smith M , Rochon P , Ray C . Traversing the renal pelvis during percutaneous nephrostomy tube placement (“Kidney Kabob”). Semin Intervent Radiol. 2012; 29 (2): 150- 2.

[18] Hausegger KA , Portugaller HR . Percutaneous nephrostomy and antegrade ureteral stenting: technique-indications-complications. Eur Radiol. 2006; 16 (9): 2016- 30.

[19] Zhang KP , Zhang Y , Chao M . Which is the best way for patients with ureteral obstruction? Percutaneous nephrostomy versus double J stenting. Medicine. 2022; 101 (45): e31194.

[20] Yang H , Chappidi M , Overland M , Ahn J , Bayne D , Chi T . Live renal ultrasonography facilitates double-J ureteral stent insertion at the bedside: a pilot study for the COVID-19 era. J Endourol. 2021; 35 (7): 1078- 83.

[21] Bragaru M , Multescu R , Geavlete P , Popescu R , Geavlete B . Comparison of flexible ureteroscope performance between reusable and single-use models. J Clin Med. 2023; 12 (3): 1093.

[22] Gauhar V , Chai CA , Chew BH , Singh A , Castellani D , Tailly T , et al. RIRS with disposable or reusable scopes: does it make a difference? Results from the multicenter FLEXOR study. Ther Adv Urol. 2023; 15: 175628722311580.

[23] Ofstead CL , Heymann OL , Quick MR , Johnson EA , Eiland JE , Wetzler HP . The effectiveness of sterilization for flexible ureteroscopes: a real-world study. Am J Infect Control. 2017; 45 (8): 888- 95.

[24] Xu J . A review: continuous renal replacement therapy for sepsis-associated acute kidney injury. All Life. 2023; 16: 1.

[25] Constantinescu C , Pasca S , Tat T , Teodorescu P , Vlad C , Iluta S , et al. Continuous renal replacement therapy in cytokine release syndrome following immunotherapy or cellular therapies? J Immunother Cancer. 2020; 8 (1): e000742.

[26] Zhu CY , Pan AJ , Mei Q , Chen T . Successful cure of a patient with urosepsis using a combination of extracorporeal membrane oxygenation and continuous renal replacement therapy: a case report and literature review. Chin J Traumatol. 2020; 23 (6): 372- 5.

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