Conversion of VA-to-VV ECMO Modes in the Management of Severe Community-Acquired Pneumonia Complicated by Septic Shock: A Case Report

ABSTRACT In the post-pandemic era, there has been a notable increase in the incidence of community-acquired pneumonia (CAP), with an earlier age of onset and more severe clinical symptoms. A subset of these patients requires extracorporeal membrane oxygenation (ECMO) support, either alone or in combination, to maintain hemodynamic and respiratory stability. This paper discusses a case study of a previously healthy middle-aged male who developed severe CAP due to Klebsiella pneumoniae (Kp), escalating to septic shock. During his hospitalization, the patient experienced a range of complications, such as septic shock, septic cardiomyopathy, acute kidney injury, lung abscess, empyema, pyopneumothorax, gastrointestinal bleeding, intestinal obstruction, and acquired myasthenia gravis. After undergoing a six-month multidisciplinary treatment regimen that included venoarterial (VA)-venovenous (VV) ECMO mode conversion, invasive mechanical ventilation (IMV), and continuous blood purification (CBP), the patient eventually demonstrated clinical improvement. This case report emphasizes the clinical characteristics and management challenges associated with severe CAP and its life-threatening complications, aiming to provide insights into effective therapeutic strategies.