A case report of acquired methemoglobinemia rescued by veno-venous extracorporeal membrane oxygenation

• Published in: Medicine (Baltimore) Vol. 100; no. 15; p. e25522
• Main Authors: Lien, Yu-Hsuan, Lin, You-Cian, Chen, Robert Jeenchen
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkins 16-04-2021
• Subjects: Clinical Case Report; Diagnosis, Differential; Extracorporeal Membrane Oxygenation - methods; Heart Arrest - diagnosis; Heart Arrest - etiology; Heart Arrest - therapy; Humans; Male; Methemoglobinemia - complications; Methemoglobinemia - diagnosis; Methemoglobinemia - therapy; Young Adult
• ISSN: 0025-7974; 1536-5964
• DOI: 10.1097/MD.0000000000025522

Severe methemoglobinemia (Met-Hb) is rare. The delayed diagnosis and treatment often cause further damage. The management of cellular hypoxemia is challenging and the use of extra-corporeal membrane oxygenation (ECMO) has never been reported.
The young patient, healthy with unremarkable past medical history, was sent to emergency room with out-of-hospital circulatory arrest (OHCA) and severe generalized cyanosis. His family reported he ingested sodium nitrite accidentally.
After successful resuscitation and return of spontaneous circulation (ROSC), the paradoxically normal arterial blood gas (ABG) with the unusual brownish blood led to the suspicion of Met-Hb. The lab test confirmed it and showed a very high level of 80%.
Because of recovered and normal cardiac function, we placed veno-venous extracorporeal membrane oxygenation (VV-ECMO) for tissue hypoxemia in addition to exchange transfusion, vitamin C, and methylene blue.
Met-Hb blood level dropped rapidly. After vigorous rehabilitation for weeks, the patient was able to be discharged home without major neurological sequela.
VV-ECMO can hyper-oxygenate the hypoxemic tissue regardless the etiology and minimize hypoxemia-reperfusion injury while awaiting the definite diagnosis and therapy.