Veno-venous extracorporeal membrane oxygenation support in the resuscitation from extreme metabolic acidosis (pH < 6.5) after drowning cardiac arrest: a case report

BACKGROUND: Resuscitation in drowning victim with cardiac arrest is difficult because of severe metabolic acidosis and multiple organ dysfunction. There is insufficient evidence to support that veno-venous extracorporeal membrane oxygenation (VV-ECMO) is beneficial for patient. CASE PRESENTATION: A 44-year-old female was trapped under river when she attempted to rescue her drowning father. Furthermore, she underwent a loss of consciousness, with extreme metabolic acidosis, hypothermia and hypotension. Hence, the VV-ECMO, continuous renal replacement therapy (CRRT) and other resuscitative infusion were required. In this case, the patient did not experience any complication or neurologic deficit and reaching a complete recovery after 21 days of hospitalization. CONCLUSIONS: Our case adds further concerns in supporting a patient with extreme metabolic acidosis (pH < 6.5) and hypothermia after severe drowning cardiac arrest, including extracorporeal life support, renal support, targeted temperature management, cerebral resuscitation, etc., due to the reversible nature of this condition.