MRSA sepsis and ARDS; Is it an indication for ECMO? Philip Hsiao BS, Joseph Miessau MS, Harrison Pitcher MD, Qiong Yang MD, Michael Baram MD, Nicholas Cavarocchi MD, Hitoshi Hirose MD,PhD. Thomas Jefferson University, Philadelphia, PA

Presentation 39 yo African American Female presents with respiratory distress 2 days after ECRP for pancreatitis. Patient quickly deteriorates, required intubation and developed severe hypotension requiring vasopressors. Pre Ecmo ABG: pH 7.01, PaCO2 70, PaO2 70 with Fi02 100% with PEEP 15 Preliminary results of cultures were negative at ECMO placement. VA-ECMO started for ARDS and SIRS due to ongoing pancreatitis.

Intervention/Results Subsequent blood/sputum cultures came back positive for MRSA, and persisted despite appropriate antibiotic coverage CXR and CT chest worsened with formation of multiple pulmonary cavitary like lesions

Results On POD#3, patient was found comatose and cerebral oximetry dropped from baseline 20% bilaterally Emergent CT scan of head showed bilateral embolic strokes in occipital and temporal regions

Results/Conclusions Post mortem autopsy showed multiple pancreatic and lung abscesses. This case illustrates that MRSA bacteremia is a major contraindication for the use of ECMO. Cerebral oximetry was useful for detection of major stroke.