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In a remarkable feat of medical expertise and coordinated critical care, doctors at Kauvery Hospital, Marathahalli, successfully saved the life of a 28-year-old woman who was battling severe bisoprolol toxicity—a condition that pushed her into multi-organ failure and cardiogenic shock. The young woman, who had intentionally overdosed on the beta-blocker bisoprolol, had already endured five days of intensive treatment at another hospital, but her condition continued to deteriorate despite high-dose insulin therapy, ventilator support, and dialysis.

Faced with a grim prognosis, her family approached Dr Harish Mallapura Maheshwarappa (Director Institute of Critical Care Medicine, Kauvery Hospitals, Bengaluru) and made a desperate decision—to shift her to Kauvery Hospital, Marathahalli, a leading center for ECMO and critical care. The transfer was a high-risk endeavor, but what followed was nothing short of a medical miracle.

A Race Against Time

By the time she reached Kauvery Hospital, the patient was in severe shock, dependent on triple inotropic support, struggling with 100% oxygen dependency, and experiencing severe metabolic acidosis due to acute pulmonary edema and acute kidney injury (AKI). She had already undergone SLED dialysis twice at the referring hospital, but her kidney function had not improved.

Recognizing the urgency of the situation, Dr. Harish and ECMO critical care team (Dr Abbas, Dr Gururaj, Dr Shridhar, Dr Goura and Dr Ashwini) along with the ER, CTVS, and nephrology teams, immediately sprang into action. Within minutes of her arrival, the patient was initiated on Veno-Arterial (V-A) ECMO support via femoro-femoral cannulation.

“Given the severity of her condition, this was her only chance. We knew the risks, but we had to act fast,” said Dr. Harish M.M.

Managing Complications: The Battle for Survival

While ECMO stabilized her hemodynamics, it was far from smooth sailing. The patient developed Harlequin Syndrome (North-South Syndrome)—a dangerous ECMO complication where oxygenated and deoxygenated blood mix, leading to differential hypoxia in the body. In most cases, this necessitates a switch to Veno-Arterial-Venous (V-AV) ECMO, but the team at Kauvery Hospital took a calculated risk.

Instead of transitioning to a hybrid ECMO setup, they aggressively managed fluid removal, tolerated higher PEEP (positive end-expiratory pressure) and peak airway pressures, and carefully monitored her oxygenation levels. The approach paid off—her oxygenation improved rapidly, and she avoided hybrid ECMO altogether.

The Turning Point: Beating the Odds

Once her lung function stabilized, the medical team focused on weaning her off ECMO. After five days, she was successfully decannulated, and by day seven, she was extubated—a remarkable recovery given the initial prognosis.

However, new challenges emerged. The patient developed sepsis (Klebsiella pneumonia, Staphylococcal bacteremia) and experienced severe coagulopathy, thrombocytopenia, and massive bleeding from her gastrointestinal tract, oral cavity, and cannula sites. The CTVS team had to perform bedside surgical re-exploration and hematoma evacuation, while massive blood transfusions were administered to correct her coagulation abnormalities.

Despite these complications, her body gradually fought back. With continuous dialysis for three days, her kidney function recovered, and her multi-organ dysfunction started reversing.

The Road to Recovery

After three weeks in the hospital, the young woman walked out of Kauvery Hospital, ready to resume her normal life. Though she developed critical illness myopathy, physiotherapy and rehabilitation ensured that she regained her strength.

“Her recovery is a testament to the power of advanced critical care and ECMO expertise. Cases like this highlight the importance of early intervention, a multidisciplinary approach, and precise clinical judgment,” said Dr. Harish, reflecting on the case.

A Testament to Excellence in ECMO Care

The successful management of this case underscores Kauvery Hospital’s leadership in advanced ECMO and critical care. The hospital’s ECMO program, led by Dr. Harish M.M with Dr. Mohammad Abbas, Dr Rajesh, Dr. Chiran, Dr Vikas, Dr Mahendra was instrumental in ensuring the patient’s survival. The ER team (Dr. Surendar), CTVS team (Dr. Rajesh, Dr. Vikas), perfusionist team (Mr Tejas), and nephrology team (Dr. Ravindra and Dr. Nishchay) played a crucial role in her round-the-clock care.

Beyond the technical excellence, the case demonstrated Kauvery Hospital’s commitment to holistic patient care—where advanced technology meets expert clinical decision-making and compassionate care.

Today, the 28-year-old survivor is back on her feet, expected to return to work in the coming weeks. From the brink of death to a new lease on life, her journey is a story of resilience, teamwork, and medical brilliance—a reminder that even in the darkest hours, hope prevails.