Here we reported a case of out-of-hospital cardiac arrest (OHCA) due to septic shock in a 70-year-old Asian man. To the best of our knowledge, this is the first case report to highlight the effectiveness of ECMO on cardiac arrest caused by rapidly progressing STSS. GAS is the most common and frequent causative pathogen of acute pharyngitis, accounting for 10–30% of cases in children and 5–10% of cases in adults [
4]. However, streptococcal infections are also known to occasionally progress to STSS on rare occasions, in which patients show rapidly worsening clinical conditions and very poor prognoses. A retrospective study involving 3566 case-patients with severe
Streptococcus pyogenes infection, in which 698 (20%) patients died within 30 days of culture-positive specimens being obtained, indicated that the survival probability was lowest among patients in whom STSS developed: 26% of patients with STSS died of septic shock within a day of specimen collection [
5]. The utility of ECMO in adults with sepsis remains controversial. In the current case, the patient presented with cardiac arrest, which is resistant to conventional resuscitation; therefore, ECMO was introduced promptly. Although there is a paucity of data supporting the use of ECMO in this spectrum of pathologic conditions, several recent reports have suggested that ECMO can become a valuable therapeutic option for patients with refractory cardiovascular dysfunction, especially when introduced promptly after developing septic shock. A recent retrospective analysis of 151 adult patients with sepsis receiving ECMO claimed that worse outcomes were significantly associated with longer door-to-ECMO times, because delayed rescue leads to irreversible multiorgan failure [
6]. Moreover, another study showed that the development of shock beyond 30.5 hours before ECMO initiation was associated with 0% survival. However, even after successful weaning from ECMO, the prognosis is reported to be poor. That study also reported that among 40.6% of the patients who were successfully weaned from ECMO, only half (21.9%) survived the refractory septic shock [
7].
One of the possible explanations for such poor prognoses after successful weaning from ECMO is the delay in the identification of the pathogenic bacteria and the following treatment. A significant disadvantage of culturing a sample is the delay of 1–2 days to obtain results. This delay may cause initiation of inappropriate antibiotic therapy and could be fatal, especially in STSS owing to the rapid progression. Further, indiscriminate use of antibiotics may result in unnecessary adverse reactions, antibiotic resistance, and increased health care costs. Recently, high sensitivity-based and specificity-based optical immunoassay technologies for detecting GAS antigen have become available [
8‐
10], in which the results can be obtained within 5–10 minutes. This could allow for prompt treatment of patients with STSS with the appropriate antibiotic and reduce the risk for overuse of antibiotic treatment in uncertain situations while culture results are pending. Early treatment may lead to more rapid improvement of the patient’s general condition, as seen in the current case.