Case Report: Left Ventricular Unloading Using a Mechanical CPR Device in a Prolonged Accidental Hypothermic Cardiac Arrest Treated by VA-ECMO – a Novel Approach
| Autor: | Jonas Quitt, Ayham Darwisch, Simon A. Amacher, Martin Siegemund, Urs Zenklusen, Eva Hammel |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Aortic arch
medicine.medical_treatment Case Report cardiac arrest Cardiovascular Medicine 030204 cardiovascular system & hematology Return of spontaneous circulation extracorporeal life support cardiopulmonary resuscitation 03 medical and health sciences 0302 clinical medicine medicine.artery accidental hypothermia medicine Retrograde perfusion Diseases of the circulatory (Cardiovascular) system Renal replacement therapy Cardiopulmonary resuscitation business.industry Acute kidney injury harlequin syndrome 030208 emergency & critical care medicine Hemothorax medicine.disease surgical procedures operative left ventricular unloading Anesthesia RC666-701 Ventricular fibrillation Cardiology and Cardiovascular Medicine business |
| Zdroj: | Frontiers in Cardiovascular Medicine, Vol 8 (2021) Frontiers in Cardiovascular Medicine |
| DOI: | 10.3389/fcvm.2021.707663/full |
| Popis: | We recently treated a 36-year-old previously healthy male with a prolonged hypothermic (lowest temperature 22.3°C) cardiac arrest after an alcohol intoxication with a return of spontaneous circulation after 230min of mechanical cardiopulmonary resuscitation and rewarming by veno-arterial ECMO with femoral cannulation and retrograde perfusion of the aortic arch. Despite functional veno-arterial ECMO, we continued mechanical cardiopulmonary resuscitation (Auto Pulse™ device, ZOLL Medical Corporation, Chelmsford, USA) until return of spontaneous circulation to prevent left ventricular distention from persistent ventricular fibrillation. The case was further complicated by extensive trauma caused by mechanical cardiopulmonary resuscitation (multiple rib fractures, significant hemothorax, and a liver laceration requiring massive transfusion), lung failure necessitating a secondary switch to veno-venous ECMO, and acute kidney injury with the need for renal replacement therapy. Shortly after return of spontaneous circulation, the patient was already following commands and could be discharged 3 weeks later without neurologic, cardiac, or renal sequelae and being entirely well. Prolonged accidental hypothermic cardiac arrest might present with excellent outcomes when supported with veno-arterial ECMO. Until return of spontaneous circulation, one might consider continuing with mechanical cardiopulmonary resuscitation in addition to ECMO to allow some left ventricular unloading. However, the clinician should keep in mind that prolonged mechanical cardiopulmonary resuscitation may cause severe injuries. |
| Databáze: | OpenAIRE |
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