Successful Management of Refractory Heart Failure and Multi-Organ Dysfunction in a Patient with CRT-D and Acute Pulmonary Edema: A Case Report

Abstract

Introduction: Heart failure with reduced ejection fraction (HFrEF) is a progressive condition often complicated by acute decompensations that require advanced medical interventions. Cardiac resynchronization therapy with a defibrillator (CRT-D) has significantly improved outcomes in patients with severe heart failure. However, challenges persist when faced with acute events such as pulmonary edema, pneumonia, and multi-organ dysfunction syndrome. Multidisciplinary, intensive care unit (ICU)-based management is critical for these complex cases. This case report presents the successful management of a 61-year-old female patient with a history of severe HFrEF and implanted CRT-D. Despite severe hypoxemia, hypotension, and metabolic acidosis, a multidisciplinary approach—including mechanical ventilation, intra-aortic balloon pump (IABP), continuous renal replacement therapy (CRRT), and transfusion—enabled recovery. The patient was admitted to the ICU with acute pulmonary edema, pneumonia, and multi-organ dysfunction syndrome, characterized by severe hypoxemia, hypotension, and metabolic acidosis. Over three weeks, the patient regained hemodynamic stability, renal function, and respiratory independence. This case demonstrates the potential for recovery in patients with severe heart failure complicated by acute pulmonary edema and multi-organ dysfunction when treated with an integrated, multidisciplinary approach. Conclusion: Advanced critical care strategies, including mechanical ventilation, intra-aortic balloon pump support, and continuous renal replacement therapy, were essential in stabilizing the patient. The outcome underscores the value of personalized, team-based critical care in managing life-threatening complications in heart failure patients with CRT-D.

Keywords

• Heart failure
• HFrEF
• CRT-D
• APE
• MOD
• IABP