Influenza‐Induced Rhabdomyolysis Leading to Hyperkalemic Cardiac Arrest Managed With Venoarterial Extracorporeal Membrane Oxygenation: A Case Report
Yoshihiro Miyake, Tomohiro Abe, Kei Tokunaga, Shihoko Shimazu, Tatsuya Tanaka, Akira Sasaki, Masaru Hiyoshi, Toshiki Tanahashi, Kohei Moribayashi, Koichi Kaikita, Hidenobu OchiaiABSTRACT
Background
Influenza‐induced rhabdomyolysis is an uncommon but serious complication that can cause life‐threatening hyperkalemia. The use of venoarterial extracorporeal membrane oxygenation (VA‐ECMO) for hyperkalemic cardiac arrest has rarely been described.
Case Presentation
A 48‐year‐old woman with influenza A developed severe rhabdomyolysis (creatine kinase: 255,240 U/L) and progressive hyperkalemia despite improved renal function and continuous renal replacement therapy. On hospital day 3, the patient experienced a hyperkalemic cardiac arrest and VA‐ECMO was initiated after 29 min of low‐flow time. Treatment for hyperkalemia was continued, and cardiac function gradually recovered, allowing the removal of ECMO on day 8. However, she later developed hemorrhagic complications related to mechanical circulatory support and died on hospital day 89.
Conclusion
Influenza‐induced rhabdomyolysis can cause rapid, life‐threatening hyperkalemia, even in patients with improving renal function. Temporary mechanical circulatory support may serve as a bridge through the acute reversible phase, and device‐related complications should be considered.