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.
Highlights
In severe respiratory disorder, it would be more effective to change to VV-extracorporeal membrane oxygenation (ECMO) after recovering from cardiogenic shock while removing superabundant fluid using continuous hemodiafiltration
Mendation regarding extracorporeal cardiopulmonary resuscitation (ECPR): “In settings where it can be rapidly implemented, ECPR may be considered for select cardiac arrest patients for whom the suspected etiology of the cardiac arrest is potentially reversible during a limited period of mechanical cardiorespiratory support (Class IIb, LOE C-LD)” [1]
After handling about 20 ECPR cases per year, we describe a successful treatment of a case with sustained ventricular fibrillation (VF) admitted to our hospital and predicted to have a bad neurological outcome because of severely abnormal blood tests date, hemorrhage and respiratory disorder
Summary
Out-of-hospital cardiac arrest (OHCA) patients who did not achieve return of spontaneous circulation (ROSC) with conventional cardiopulmonary resuscitation (CPR) demonstrated improved neurologic outcomes with ECPR compared to continued conventional CPR [2] [3]. ECPR is a valid treatment, it is not easy to perform and has its complications. After handling about 20 ECPR cases per year, we describe a successful treatment of a case with sustained VF admitted to our hospital and predicted to have a bad neurological outcome because of severely abnormal blood tests date, hemorrhage and respiratory disorder.
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