Extracorporeal Membrane Oxygenation as Support for Cardiogenic Shock Induced by High Voltage Electrical Injury

Introduction

High voltage electrical injury (HVEI) of more than 1,000V is a potentially devastating form of a multisystem injury associated with high morbidity and mortality.

We present here the use of ECMO as a life saving device treating a patient with severe cardiogenic shock after a high voltage electrical injury

Case Presentation

A 26-year-old male sustained HVEI while working with a concrete mixer pump that came in contact with a high voltage cable of 10,000 volts.

He was immediately disconnected from the mixer pump, underwent cardiopulmonary resuscitation and transported to the nearest medical centre with severe cardiogenic shock (EF < 10%).

Upon arrival he was in critical condition, sedated and mechanically ventilated, haemodynamically unstable and supported by IV inotropes after a few events of ventricular fibrillation, with an electrical entry point on the left hand and an exit point in his right leg.

Blood pH was 6.8, PCO2 53 mmHg, PaO₂ of 57 mmHg, Lactate 8 mmol/L, and Troponin 38000 ng/dl. EF was 10% with a global severe left ventricular dysfunction.

During CPR including cardiac massage and few electrical shocks he was immediately connected to the VA-ECMO via open right femoral approach with distal arterial leg perfusion.

He was treated with IV broad spectrum antibiotics, and high volume fluids to prevent rhabdomyolysis-induced acute kidney injury, total parenteral nutrition, topical silver sulfadiazine cream, and Granuflex for severe electrical burns.

Outcomes

He was gradually weaned from inotropes over the next 3 days, during which his clinical condition and bloodwork improved tremendously. His EF gradually increased to 50% and he was weaned from the ECMO and underwent decannulation 86 hours after initialization.

He was discharged on day 27 without any sequelae.