TITLE:
Use of Extracorporeal Cardiopulmonary Resuscitation in a Fatal Case of Pneumococcal Septic Shock Post-Splenectomy: A Case Report and Literature Review
AUTHORS:
Luke Delfosse, Marc Sabbe
KEYWORDS:
Streptococcus Pneumoniae, Septic Shock, Asplenic, Overwhelming Post-Splenectomy Infection, Extracorporeal Cardiopulmonary Resuscitation
JOURNAL NAME:
Case Reports in Clinical Medicine,
Vol.14 No.9,
September
18,
2025
ABSTRACT: Overwhelming Post-Splenectomy Infection (OPSI) is a rare but recognized life-threatening infection in patients with a history of splenectomy. These patients are susceptible to severe infections with encapsulated bacteria, especially in unvaccinated individuals. The role of Venoarterial Extracorporeal Membrane Oxygenation (VA-ECMO) in adult patients with sepsis remains disputed. While the European Resuscitation Council endorses Extracorporeal cardiopulmonary Resuscitation (ECPR) as a rescue strategy when standard Advanced Life Support (ALS) measures fail, its application in cases of cardiac arrest secondary to sepsis is not addressed in the latest guidelines. Similarly, the latest revision of the Surviving Sepsis Campaign Guidelines provides no specific recommendations regarding VA-ECMO in circulatory collapse. We report a case of a 34-year-old male, post-splenectomy due to Evans syndrome, who presented with flu-like symptoms that rapidly deteriorated into septic shock and cardiac arrest. ALS was initiated immediately. Following the witnessed In-Hospital Cardiac Arrest (IHCA), the ECPR protocol was implemented. Despite comprehensive interventions, the patient died. Blood cultures proved positive for streptococcus pneumoniae. Although numerous case reports describe successful use of VA-ECMO or ECPR in septic shock, reports of fatal outcomes remain exceedingly rare. With this case we intend to offer a more balanced perspective on the potential limitations and risks of VA-ECMO or ECPR in septic shock, addressing the likelihood of publication bias that favors reports of positive outcomes.