DOI: 10.12890/2026_005968

Sequential extracorporeal organ support in refractory septic shock: a novel combo approach with complete recovery: a case report and literature review

Authors

  • Khaled Sewify Critical Care Department, King Fahad Military Medical Complex, Dhahran, Saudi Arabia
  • Donia Elmasry Critical Care Department, King Fahad Military Medical Complex, Dhahran, Saudi Arabia
  • Ahmad Aboutaleb Critical Care Department, King Fahad Military Medical Complex, Dhahran, Saudi Arabia
  • Ahmed Abualsaud Critical Care Department, King Fahad Military Medical Complex, Dhahran, Saudi Arabia
  • Abdelaziz Alshaer Critical Care Department, King Fahad Military Medical Complex, Dhahran, Saudi Arabia
  • Hani Hosny Emergency Department, Prince Sultan Medical College, Dhahran, Saudi Arabia
  • Ahmed Sewify ARC Industrial Transformation Training Centre (ITTC) for Joint Biomechanics, Queensland University of Technology, Brisbane, Australia

drsewafie@hotmail.com

Keywords

Continuous renal replacement therapy, Oxiris hemofilter, ECCO2R, IgM/IgA-enriched intravenous immunoglobulin, refractory septic shock

Abstract

Introduction: Refractory septic shock and multiple organ dysfunction syndrome (MODS) remain a critical challenge in intensive care because they are associated with high morbidity and mortality despite advanced care.
Case description: This case report describes the successful management of a 74-year-old female patient admitted with coronavirus disease 2019 (COVID-19) infection complicated by severe acute respiratory distress syndrome, refractory septic shock and MODS, including acute kidney injury and gastrointestinal bleeding. The patient received three sequential interventions, including continuous renal replacement therapy with the Oxiris hemofilter (Baxter International Inc, Deerfield, IL, USA) for cytokine/endotoxin removal, integrated extracorporeal CO2 removal (ECCO2R) via a single vascular access, and adjunctive IgM/IgA-enriched intravenous immunoglobulin therapy. The combined interventions resulted in a 74% reduction in C-reactive protein (325 to 85 mg/l), a 92% reduction in procalcitonin (28.3 to 2.3 ng/ml), normalization of hypercapnia (PCO2 107 to 48 mmHg) within 24h, and successful vasopressor discontinuation within 12 days. The patient recovered completely without any sequelae.
Conclusion: This case report demonstrates how coordinated extracorporeal organ support can produce beneficial effects in patients with refractory septic shock. The combined treatment provided renal, respiratory, and immunologic support through minimal vascular access and warrants further investigation in controlled trials.

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References

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Published

2026-03-06

Issue

Vol. 13 No. 4 (2026)

Categories

How to Cite

1.
Sewify K, Elmasry D, Aboutaleb A, Abualsaud A, Alshaer A, Hosny H, et al. Sequential extracorporeal organ support in refractory septic shock: a novel combo approach with complete recovery: a case report and literature review. EJCRIM [Internet]. 2026 Mar. 6 [cited 2026 Nov. 3];13(4). Available from: https://ejcrim.com/index.php/ejcrim/article/view/5968

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