Use of Intravenous Immunoglobulins in Patients With Suspected Toxin-Mediated Shock Requiring Extracorporeal Membrane Oxygenation

BACKGROUND: Toxin-producing, Gram-positive bacteria, can lead to severe and refractory septic shock with high attributable mortality. Adjunctive therapies such as intravenous immunoglobulins (IVIG) have been proposed for these patients. However, at presentation the presence of a toxin-producing organism is most often unknown. As IVIG is a potentially valuable but also limited resource, we investigated the use of IVIG in our critically ill patients requiring extracorporeal membrane oxygenation (ECMO). MATERIALS AND METHODS: Retrospective cohort study (April 2016-March 2018) of adult patients with clinically suspected toxin-mediated shock requiring ECMO and who received IVIG in our regional severe respiratory failure (SRF)/ ECMO centre. RESULTS: In 44% (15/34) of the patients, group A Streptococcus or Panton-Valentine Leukocidin producing S. aureus was isolated. IVIG use in these patients was safe. The mortality was 30%, lower than the predicted mortality of >90% based on the SOFA scores. CONCLUSION: IVIG administration can be considered in a selected group of patients presenting with acute and very severe septic shock.