Multi-phasic life-threatening anaphylaxis refractory to epinephrine managed by extracorporeal membrane oxygenation (ECMO): A case report

Juergen Grafeneder; Florian Ettl; Alexandra-Maria Warenits; Nina Buchtele; Elisabeth Lobmeyr; Thomas Staudinger; Michael Schwameis; Wolfgang R Sperr; Georg Gelbenegger; Christian Schoergenhofer; Bernd Jilma

doi:10.3389/falgy.2022.934436

Multi-phasic life-threatening anaphylaxis refractory to epinephrine managed by extracorporeal membrane oxygenation (ECMO): A case report

Front Allergy. 2022 Jul 29:3:934436. doi: 10.3389/falgy.2022.934436. eCollection 2022.

Affiliations

¹ Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria.
² Intensive Care Unit 13i2, Division of Hematology and Hemostaseology, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria.
³ Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria.

Abstract

We present a case of a 52-year-old patient suffering from multi-phasic life-threatening anaphylaxis refractory to epinephrine treatment. Extracorporeal membrane oxygenation (ECMO) therapy was initiated as the ultima ratio to stabilize the patient hemodynamically during episodic severe bronchospasm. ECMO treatment was successfully weaned after 4 days. Mastocytosis was diagnosed as the underlying condition. Although epinephrine is recommended as a first-line treatment for anaphylaxis, this impressive case provides clear evidence of its limited therapeutic success and emphasizes the need for causal therapies.

Keywords: MCAS; anaphylactic shock; bronchospasm; epinephrine resistance; extracorporeal membrane oxygenation (ECMO); mastocytosis; respiratory failure.