Key result
Salvage surgical resection allowed weaning from VA-ECMO in a 19-year-old pregnant patient with primary mediastinal large B-cell lymphoma presenting in cardiogenic shock.
Case Report (n=1)
Salvage surgical resection may be considered as a last resort to facilitate weaning from VA-ECMO in patients with primary mediastinal large B-cell lymphoma presenting with cardiogenic shock who do not respond to chemotherapy.
May support salvage resection for ECMO weaning in refractory PMBCL shock; hypothesis-generating and requires prospective validation.
Primary mediastinal large B-cell lymphoma (PMBCL) is a rare type of non-Hodgkin lymphoma that typically has a good response rate to first line chemotherapy regimens. There have been reports of successful chemotherapy, but with a residual mass from fibrosis. Here, we report the case of a 19-year-old primigravida presenting with cardiogenic shock and superior vena cava (SVC) syndrome at full term who was found to have a PMBCL. Following delivery via urgent cesarean section, she was put on veno-arterial extra corporeal membrane oxygenation (VA-ECMO) and once hemodynamically stable was started on chemotherapy. In view of limited change in tumor size on consecutive CT scans and questionable response to chemotherapy, there were multidisciplinary meetings wherein withdrawing support was discussed and put forward to the family. At that point, surgical debulking was offered on compassionate grounds to be able to wean her off the VA-ECMO. This case report highlights the role of salvage resection when there are no other options.
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Carro et al. (2019) conducted a case report in Primary mediastinal large B-cell lymphoma presenting with cardiogenic shock and superior vena cava syndrome (n=1). Salvage surgical resection was evaluated on Weaning off VA-ECMO. Salvage surgical resection allowed weaning from VA-ECMO in a 19-year-old pregnant patient with primary mediastinal large B-cell lymphoma presenting in cardiogenic shock.
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