Unexpectedly Good Neurological Outcome after Prolonged Cardiac Arrest

Abstract

Backgoround: Generally, neurological outcome of patients who have achieved return of spontaneous circulations (ROSC) with abnormal blood tests date and some severe organ complications is extremely poor. Because we experienced a case of good neurological outcome using two different types of extracorporeal membrane oxygenation (ECMO) in spite of prolonged cardiac arrest, we reported this case and reviewed the literature. Case presentation: A 36-year-old male suddenly collapsed at bar after drinking. Initial ECG showed ventricular fibrillation (VF) and subsequently underwent advanced cardiovascular life support. On admission, the ECG still showed VF, but pupillary light reflex was faintly present. Then, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support was established 54 minutes after collapse. Blood tests showed lactate was 15.8 mmol/l and NH3 of 251 μg/dl. To improve respiratory function after cardiogenic shock, we changed to veno-venous ECMO (VV-ECMO) and removed superabundant fluid using continuous hemodiafiltration. Patient was discharged on day-26 after a full functional recovery. Conclusion: In severe respiratory disorder, it would be more effective to change to VV-ECMO after recovering from cardiogenic shock while removing superabundant fluid using continuous hemodiafiltration. In predicting the neurological outcome of a post cardiac arrest patient, the presence of a pupillary light reflex may be more significant than NH3 and lactate.