Parallel Venovenous and Venoarterial Extracorporeal Membrane Oxygenation for Differential Titration of Cardiopulmonary Support in Combined Severe Cardiac and Respiratory Failure: A Case Report.

Authors

Ikutaro Yamashita, Kosei Omasa, Shokei Matsumoto, Masayuki Shimizu

Published in

Journal of chest surgery. Sep 30, 2026. Epub Sep 30, 2026.

Abstract

Parallel venovenous (VV) and venoarterial (VA) extracorporeal membrane oxygenation (ECMO) can allow separate titration of respiratory and circulatory support in patients with concurrent severe cardiopulmonary failure. A 64-year-old woman with central hypopituitarism developed cytomegalovirus infection with hemophagocytic lymphohistiocytosis, followed by severe Pseudomonas aeruginosa pneumonia and septic cardiomyopathy. Despite VV-ECMO and intra-aortic balloon pump support, refractory cardiogenic shock required the addition of VA-ECMO. After parallel ECMO was initiated, hemodynamics improved rapidly, and vasopressors were discontinued within 4 hours. A key feature of this case was the transition from VA-dominant to VV-dominant support as myocardial function recovered while respiratory failure continued to require VV-ECMO. VA-ECMO was discontinued on hospital day 17, and VV-ECMO was removed on hospital day 28. The patient was discharged for rehabilitation on hospital day 109. This case illustrates that parallel VV- and VA-ECMO may provide rescue support for selected patients with refractory cardiopulmonary failure when conventional ECMO configurations are insufficient.

PMID:
42811764
Bibliographic data and abstract were imported from PubMed on 30 Sep 2026.

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