Abstract

BackgroundPulseless electrical activity cardiac arrest is associated with poor outcomes and the identification of potentially reversible reasons for cardiac arrest is fundamental.Case presentationWe describe the case of a 46-year-old male with the rare coincidental finding of supravalvular aortic stenosis and coronary vasospasm leading to recurrent pulseless electrical activity cardiac arrest. Extracorporeal life support was successfully applied for hemodynamic stabilization. Supravalvular aorticstenosis underwent surgical repair. The patient survived five time resuscitation and was discharged after full neurological recovery.ConclusionsCoronary vasospasm and supravalvular aortic stenosis are rare but potentially reversible causes of pulseless electrical activity cardiac arrest. Extracorporeal life support allows accurate diagnostic and possibly therapy even of uncommon reasons for cardiac arrest.Electronic supplementary materialThe online version of this article (doi:10.1186/s12872-016-0284-5) contains supplementary material, which is available to authorized users.

Highlights

  • Pulseless electrical activity cardiac arrest is associated with poor outcomes and the identification of potentially reversible reasons for cardiac arrest is fundamental

  • We describe here for the first time the case of a patient with the rare coincident finding of coronary vasospasm and supravalvular aortic stenosis leading to recurrent pulseless electrical activity cardiac arrests

  • Because of the development of a severe acute respiratory distress syndrome five days after admission our extracorporeal membrane oxygenation (ECMO) team established a veno-venous extra-corporeal membrane oxygenation system using a 31 Fr bi-caval cannula and transferred the patient to our Lother et al BMC Cardiovascular Disorders (2016) 16:100. During his stay in the intensive care unit the patient underwent recurrent episodes of cardiac arrest with pulseless electrical activity (PEA, Fig. 1, Fig. 2c) that were not associated with hypoxemia as he was on full ECMO support

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Summary

Background

Cardiac arrest due to pulseless electrical activity (PEA) is associated with poor survival and neurological outcome when compared to a shockable rhythm [1, 2]. Sufficient oxygenation was delivered by combined ECMO treatment and lung protective ventilation During his stay in the intensive care unit the patient underwent recurrent episodes of cardiac arrest with pulseless electrical activity (PEA, Fig. 1, Fig. 2c) that were not associated with hypoxemia as he was on full ECMO support. As we could not reach a return of spontaneous circulation after 15 min of resuscitation we successfully modified the established vvECMO to a veno-veno-arterial ECMO system by introduction of a 17 Fr delivering cannula into the right femoral artery in order to provide extracorporeal life support (ECLS). This procedure could be performed within 15 min without complications under ongoing CPR. A cardiac defibrillator was implanted for secondary prevention of the initial VF

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