Successful Treatment of Sepsis-Induced Cardiomyopathy with Intra-Aortic Balloon Pumping: A Case Report and Literature Review

Abstract

BACKGROUND Sepsis-induced cardiomyopathy is cardiac dysfunction in sepsis that sometimes results in reduced cardiac output. Inotropic agents are recommended in patients with sepsis and cardiac dysfunction. Here, we present a case of sepsis-induced cardiomyopathy that was resistant to inotropes and was successfully treated with intra-aortic balloon pumping (IABP). We also reviewed the literature on similar cases of sepsis-induced cardiomyopathy treated with IABP. CASE REPORT A 40-year-old woman with fever and hypotension was admitted to a university hospital. Laboratory test results showed elevated inflammatory markers and cardiac markers, such as creatinine kinase-MB and troponin T. Echocardiography revealed severe left ventricular hypokinesis, and cardiac monitoring revealed a low cardiac output. The patient received antimicrobials, vasopressors, and dobutamine; however, her circulatory status did not respond to these treatments. IABP was introduced 7 h after admission and dramatically increased her blood pressure and cardiac output, resulting in the reduction of vasopressor and dobutamine doses. The patient survived without any IABP-related complications. The literature review of 11 cases of sepsis-induced cardiomyopathy treated with IABP shows consistent results with the presented case in terms of positive effects of IABP on circulatory status and cardiac function, resulting in a reduction of inotropes. CONCLUSIONS Some sepsis-induced cardiomyopathy cases with reduced left ventricular function may not respond to inotropes. IABP would be a treatment option for these patients because of its positive effects on cardiac and circulatory functions.

Figure 1.

Electrocardiography findings on arrival. Electrocardiography reveals ST elevation in II, III, aVF, and V4–6 (black arrowheads) and ST depression in aVR and V1 (white arrowheads) without any reciprocal changes, which are not specific ST changes for ischemic heart diseases.

Figure. 2

Clinical course of this case until 24 h (A) and until 12 days (B). (A) The patient showed severe hypotension and hyperlactatemia on arrival. Despite the infusion of catecholamines and arginine vasopressin (AVP), the pulse contour cardiac index remained low. The intra-aortic balloon pumping (IABP) was introduced 7 h after admission. After IABP introduction, the mean arterial pressure increased and the lactate levels decreased. Dobutamine and noradrenaline were titrated at 24 h after admission. (B) Continuous renal replacement therapy (CRRT) and mechanical ventilation were introduced on day 1. After IABP introduction, catecholamines and AVP were titrated and discontinued by day 5. The urine volume increased from day 5 and CRRT was discontinued on day 7. Mechanical ventilation was discontinued on day 11. AVP – arginine vasopressin; CRRT – continuous renal replacement therapy; DOB – dobutamine; IABP – intra-aortic balloon pumping; Lac – lactate; MAP – mean arterial pressure; NAD – noradrenaline; PCCI – pulse contour cardiac index.