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He suffered a massive haemothorax due to perforation of the right atrial appendage. It was repaired through a sternotomy while being given massive blood transfusions. The following days, he was on VA-ECMO and double continuous venovenous haemodialysis (CVVHD). He survived with only mild paresis of the left hand. VA-ECMO should be considered a rescue therapy alongside treatment with CVVHD in case of cardiac arrest due to severe MALA.<\/jats:p>","DOI":"10.1136\/bcr-2023-254649","type":"journal-article","created":{"date-parts":[[2023,8,16]],"date-time":"2023-08-16T13:15:25Z","timestamp":1692191725000},"page":"e254649","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Surviving cardiac arrest from severe metformin-associated lactic acidosis using extracorporeal membrane oxygenation and double continuous venovenous haemodialysis"],"prefix":"10.1136","volume":"16","author":[{"given":"Kirstine Krushave","family":"Akkaoui","sequence":"first","affiliation":[{"name":"Anaesthesia and Intensive Care, Aalborg Universitetshospital, Aalborg, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ljubica Vukelic","family":"Andersen","sequence":"additional","affiliation":[{"name":"Cardiology, Aalborg Universitetshospital, Aalborg, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin Agge","family":"N\u00f8rgaard","sequence":"additional","affiliation":[{"name":"Thoracic Surgery, Aalborg Universitetshospital, Aalborg, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6615-4438","authenticated-orcid":false,"given":"Jo B\u00f8nding","family":"Andreasen","sequence":"additional","affiliation":[{"name":"Thoracic Intensive Care Unit, Aalborg Universitetshospital, Aalborg, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,8,16]]},"reference":[{"key":"2025082800404200000_16.8.e254649.1","doi-asserted-by":"crossref","unstructured":"Engler C , Leo M , Pfeifer B , et al . 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