title: Impella left ventricular assist device in cardiac arrest after spinal anaesthesia for caesarean section.
abstract: Cardiac arrest after neuraxial anaesthesia is very well described. Inhibition of the sympathetic efferent system and vagal activation leading to decrease preload and severe bradycardia results in cardiac arrest. Pregnant patients undergoing spinal anaesthesia are at increased risk for vasovagal events due to aortocaval compression and higher level of spinal block. A 36-year-old pregnant woman at 39 weeks presented for an elective caesarean section. She underwent spinal anaesthesia. Immediately after, she had severe bradycardia followed by asystole cardiac arrest. She had spontaneous return of circulation. The patient was in cardiogenic shock causing pulmonary oedema and required four vasopressors to maintain her blood pressure. An Impella 2.5 percutaneous microaxial left ventricle (LV) support device was inserted to support her haemodynamics. She fully recovered and was discharged in stable condition. To the best of our knowledge, this is first case report of the use of an LV-assist device in a patient postcardiac arrest from spinal anaesthesia.
authors.affiliation: Department of Medicine, Cooper University Hospital, Camden, New Jersey, USA.
authors.forename: Nayan
authors.initials: N
authors.lastname: Desai
authors.affiliation: Department of Cardiology, Cooper University Hospital, Camden, New Jersey, USA.
authors.forename: Kunal
authors.initials: K
authors.lastname: Chaudhry
authors.affiliation: Department of Cardiology, Cooper University Hospital, Camden, New Jersey, USA.
authors.forename: Janah
authors.initials: J
authors.lastname: Aji
mesh_terms: D000328:Adult; D000775:Anesthesia, Spinal / Q000009:adverse effects*; D002585:Cesarean Section / Q000009:adverse effects*; D005260:Female; D006323:Heart Arrest / Q000601:surgery*; D006353:Heart-Assist Devices; D006801:Humans; D011247:Pregnancy; D012770:Shock, Cardiogenic / Q000601:surgery*; D016896:Treatment Outcome