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Venoarterial extracorporeal membrane oxygenation as bridge support for refractory catecholamine-resistant shock and severe lactic acidosis in a patient with metformin exposure and multifactorial contributors: A case report Cover

Venoarterial extracorporeal membrane oxygenation as bridge support for refractory catecholamine-resistant shock and severe lactic acidosis in a patient with metformin exposure and multifactorial contributors: A case report

Open Access
|Apr 2026

References

  1. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801–10.
  2. Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Intensive Care Med. 2017;43(3):304–77.
  3. Zhang H, Xu Y, Huang X, Wu G, Ma X. Extracorporeal Membrane Oxygenation in Adult Patients with Sepsis and Septic Shock: Why, How, When, and for Whom. J Intensive Med. 2024;4(1):62–72.
  4. Dyatlova N, Tobarran NV, Kannan L, North R, Wills BK. Metformin-Associated Lactic Acidosis (MALA). In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 [cited 2026 Jan 17]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK580485/
  5. See KC. Metformin-Associated Lactic Acidosis: A Mini Review of Pathophysiology, Diagnosis and Management in Critically Ill Patients. World J Diabetes. 2024;15(6):1178–86.
  6. Angioi A, Cabiddu G, Conti M, Piras D, Atzeni A, Setzu V, et al. Metformin Associated Lactic Acidosis: A Case Series of 28 Patients Treated with Sustained Low-Efficiency Dialysis (SLED) and Long-Term Follow-Up. BMC Nephrol. 2018;19(1):77.
  7. van Berlo-van de Laar IRF, Vermeij CG, Doorenbos CJ. Metformin Associated Lactic Acidosis: Incidence and Clinical Correlation with Metformin Serum Concentration Measurements. J Clin Pharm Ther. 2011;36(3):376–82.
  8. Ott M, Werneke U. Metformin-Associated Lactic Acidosis May Be Treatable with Thiamine. Med Hypotheses. 2024;189:111416.
  9. Liang YW, Zhu YF, Zhang R, Zhang M, Ye XL, Wei JR. Incidence, Prognosis, and Risk Factors of Sepsis-Induced Cardiomyopathy. World J Clin Cases. 2021;9(31):9452–68.
  10. Hasegawa D, Ishisaka Y, Maeda T, Prasitlumkum N, Nishida K, Dugar S, et al. Prevalence and Prognosis of Sepsis-Induced Cardiomyopathy: A Systematic Review and Meta-Analysis. J Intensive Care Med. 2023;38(9):797–808.
  11. Sato R, Nasu M. A Review of Sepsis-Induced Cardiomyopathy. J Intensive Care. 2015;3:48.
  12. Broman LM, Dubrovskaja O, Balik M. Extracorporeal Membrane Oxygenation for Septic Shock in Adults and Children: A Narrative Review. J Clin Med. 2023;12(20):6661.
  13. Ling RR, Ramanathan K, Poon WH, Tan CS, Brechot N, Fan E, et al. Venoarterial Extracorporeal Membrane Oxygenation as Mechanical Circulatory Support in Adult Septic Shock: A Systematic Review and Meta-Analysis with Individual Participant Data Meta-Regression Analysis. Crit Care. 2021;25(1):246.
  14. Han L, Zhang Y, Zhang Y, Wu W, He P. Risk Factors for Refractory Septic Shock Treated with VA ECMO. Ann Transl Med. 2019;7(18):476.
  15. Fan E, Del Sorbo L, Goligher EC, Hodgson CL, Munshi L, Walkey AJ, et al. An Official American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine Clinical Practice Guideline: Mechanical Ventilation in Adult Patients with Acute Respiratory Distress Syndrome. Am J Respir Crit Care Med. 2017;195(9):1253–63.
  16. Vallabhajosyula S, Deshmukh AJ, Kashani K, Prasad A, Sakhuja A. Tako-Tsubo Cardiomyopathy in Severe Sepsis: Nationwide Trends, Predictors, and Outcomes. J Am Heart Assoc. 2018;7(18):e009160.
  17. Lin YM, Lee MC, Toh HS, Cheng AC, Peng SM, Huang CT, et al. Association of Sepsis-Induced Cardiomyopathy and Mortality: A Systematic Review and Meta-Analysis. Ann Intensive Care. 2022;12(1):112.
  18. Chu T, Pan J, Song Q, Chen J, Wu J, Lin X, et al. Risk Factors for Mortality in Patients with Sepsis on Extracorporeal Membrane Oxygenation and/or Continuous Renal Replacement Therapy: A Retrospective Cohort Study Based on MIMIC-IV Database. Ren Fail. 2024;46(2):2436106.
  19. Landesberg G, Levin PD, Gilon D, Goodman S, Georgieva M, Weissman C, et al. Myocardial Dysfunction in Severe Sepsis and Septic Shock: No Correlation With Inflammatory Cytokines in Real-Life Clinical Setting. Chest. 2015;148(1):93–102.
  20. Cheng Y, Gao H, Chen Y, Zheng J, Xu J, Lu Z, et al. Prognostic Factors of Extracorporeal Membrane Oxygenation as a Rescue Therapy for Refractory Septic Shock in Children. Pediatr Med. 2025;8:0.
  21. Koziol KJ, Isath A, Rao S, Vallabhajosyula S, Jabbari R, Gregoric ID, et al. Extracorporeal Membrane Oxygenation (VA-ECMO) in Management of Cardiogenic Shock. J Clin Med. 2023;12(17):5576.
  22. Myers LC, Lee C, Thompson BT, Cudemus G, Raz Y, Roy N. Outcomes of Adult Patients With Septic Shock Undergoing Extracorporeal Membrane Oxygenation Therapy. Ann Thorac Surg. 2020;110(3):871–7.
  23. Ro SK, Kim WK, Lim JY, Yoo JS, Hong SB, Kim JB. Extracorporeal Life Support for Adults with Refractory Septic Shock. J Thorac Cardiovasc Surg. 2018;156(3):1104–9.
DOI: https://doi.org/10.62838/jccm-2026-0017 | Journal eISSN: 2393-1817 | Journal ISSN: 2393-1809
Language: English
Page range: 300 - 305
Submitted on: Oct 26, 2025
Accepted on: Jan 30, 2026
Published on: Apr 30, 2026
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year

© 2026 Ans Alamami, Rabee Tawel, Saleh Mahmoud, Shameel Ahammed, Abdurrahmaan Elbuzidi, Nadir Kharma, published by University of Medicine, Pharmacy, Science and Technology of Targu Mures
This work is licensed under the Creative Commons Attribution 4.0 License.