Extracorporeal membrane oxygenation after protracted ventricular fibrillation cardiac arrest: case report and discussion.
Extracorporeal membrane oxygenation (ECMO) is a method to provide temporary cardiac and respiratory support to critically ill patients. In recent years, the role of ECMO in emergency departments (EDs) for select adults has increased. We present the dramatic case of a 29-year-old man who was placed on venoarterial ECMO for cardiogenic shock and respiratory failure following collapse and protracted ventricular fibrillation cardiac arrest in our ED. Resuscitation efforts prior to ECMO commencement included 49 minutes of virtually continuous cardiopulmonary resuscitation (CPR), 11 defibrillations, administration of numerous medications, including a thrombolytic agent, while CPR was ongoing, percutaneous coronary intervention and stenting for a mid-left anterior descending coronary artery dissection and thrombotic occlusion, inotropic support, and intra-aortic balloon pump counterpulsation. Over the next 48 hours following ECMO commencement, the patient's cardiorespiratory function rapidly improved, and he was discharged home 9 days after admission with no neurologic sequelae. The history, indications, and increasing role of ECMO in a range of conditions, including cardiac arrest, are reviewed.
1Department of Emergency Medicine,University of British Columbia,Vancouver,BC.
Riyad B
RB
Abu-Laban
1Department of Emergency Medicine,University of British Columbia,Vancouver,BC.
David
D
Migneault
1Department of Emergency Medicine,University of British Columbia,Vancouver,BC.
Meghan R
MR
Grant
2Division of Critical Care Medicine,University of British Columbia,Vancouver,BC.
Vinay
V
Dhingra
3Division of Cardiology,University of British Columbia,Vancouver,BC.
Anthony
A
Fung
4Division of Cardiac Surgery,University of British Columbia,Vancouver,BC.
Richard C
RC
Cook
1Department of Emergency Medicine,University of British Columbia,Vancouver,BC.
David
D
Sweet
D000328:Adult; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D006323:Heart Arrest / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D014693:Ventricular Fibrillation / Q000150:complications* / Q000628:therapy