Post-return of spontaneous circulation (ROSC) management in STEMI patient with COVID-19: a case report

Abstract

Background: The COVID-19 pandemic is still a global emergency that causes higher mortality in patients with comorbidities. Current data shows the mortality rate of STEMI patients with COVID-19 is higher than that of STEMI patients without COVID-19. This study aims to improve the knowledge and skills in managing cardiac arrest in COVID-19 patients and post-ROSC management in STEMI patients with COVID-19. Case Presentation: A 43-year-old man came with a complaint of typical chest pain 3 days before admission, accompanied by symptoms of orthopnea and dyspnea on exercise, and had experienced syncope 3 days prior. History of diabetes mellitus and previous heart attack. The examination results showed tachycardia, tachypnea and oxygen desaturase. The supporting examinations were ESR 89, CRP 48.72, D-dimer: 2.04, and HbA1C 10.1%. Swab Polymerase Chain Reaction (PCR) SARS Cov-2 showed a positive result, with pulmonary edema that may be accompanied by pneumonia (CORADS-3), bilateral pleural effusions, calcification of the descending aorta and coronary arteries LAD, LCX, RCA on computed tomography (CT) imaging. ) Thorax. On bedside echocardiography, EF 28%, LA-LV dilatation, anterior akinetic RWMA, and mild-moderate MR due to functional, mild TR were found. Patients diagnosed with STEMI anterior late onset Killip III, CCS IV, Grace 129, TIMI 9/14; ADHF on ACS; DM, Confirmed Covid-19, Hypoalbuminemia, Hypercoagulation state and had a heart attack and cardiac-respiratory arrest on the 14th day of treatment, performed cardiopulmonary resuscitation (CPR) and entered a state of return of spontaneous circulation (ROSC). The patient continued the treatment until day 23 and was referred to another hospital for further care. Conclusion: In order to obtain good results in reducing mortality in STEMI patients with COVID-19, it is necessary to have the knowledge and skills of management of cardiac arrest in COVID-19 patients and post ROSC management in STEMI patients with COVID-19, as well as pay attention to and maintaining the safety of the rescuers.