溺水患者に合併した難治性心室細動に対して大動脈内バルーンパンピングが有効と考えられた１救命例

Abstract

Cardioreversion of ventricular fibrillation (VF) is one of the major targets in the therapeutic strategy for cardiac arrest. We report a case in whom intra-aortic balloon pumping (IABP) effectively treated VF caused by submersion and in whom the neurological outcome was relatively good. An 18-year-old man drowned after diving into a swimming pool. When he was rescued after 12 minutes, he was in cardiac arrest. We started advanced cardiovascular life support just after his arrival at our emergency and critical care center. The electrocardiogram revealed VF. Despite applications of direct current defibrillation and administration of vasopressin and nifecarant, VF occurred repeatedly. After we started IABP, his cardiac rhythm and vital signs stabilized. X-ray examinations revealed a cervical spine injury and severe pulmonary edema. Normothermia therapy and IABP support were performed, and high dose methylprednisolone therapy was also carried out for the cervical spine injury. Under this intensive care regimen, the patient's status improved. His Glasgow outcome scale was severe disability on discharge from our hospital. We believe that IABP is one of the effective therapies in a patient with intractable cardiac arrhythmia. In addition, IABP may be effective for maintenance of cerebral blood flow after cardiopulmonary resuscitation.