title: Prolonged Intraoperative Cardiac Resuscitation Complicated by Intracardiac Thrombus in a Patient Undergoing Orthotopic Liver Transplantation.
abstract: We report the case of successful resuscitation after prolonged cardiac arrest during orthotopic liver transplantation. After reperfusion, the patient developed ventricular tachycardia, complicated by intracardiac clot formation and massive hemorrhage. Transesophageal echocardiography demonstrated stunned and nonfunctioning right and left ventricles, with developing intracardiac clots. Treatment with heparin, massive transfusion and prolonged cardiopulmonary resuscitation ensued for 51 minutes. Serial arterial blood gases demonstrated adequate oxygenation and ventilation during cardiopulmonary resuscitation. Cardiothoracic surgery was consulted for potential use of extracorporeal membrane oxygenation, however, the myocardial function improved and the surgery was completed without further intervention. On postoperative day 6, the patient was extubated without neurologic or cardiac impairment. The patient continues to do well 2 years posttransplant, able to perform independent daily activities of living and his previous job. This case underscores the potential for positive outcomes with profoundly prolonged, effective advanced cardiovascular life support in patients who experience postreperfusion syndrome.
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, NY, USA sang.kim@mountsinai.org.
authors.forename: Sang
authors.initials: S
authors.lastname: Kim
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Samuel
authors.initials: S
authors.lastname: DeMaria
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Edmond
authors.initials: E
authors.lastname: Cohen
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: George
authors.initials: G
authors.lastname: Silvay
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Jeron
authors.initials: J
authors.lastname: Zerillo
mesh_terms: D002315:Cardiopulmonary Bypass; D016887:Cardiopulmonary Resuscitation; D017548:Echocardiography, Transesophageal; D015199:Extracorporeal Membrane Oxygenation; D006331:Heart Diseases / Q000150:complications*; D006801:Humans; D007431:Intraoperative Complications / Q000628:therapy*; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D013927:Thrombosis / Q000150:complications*
keywords: circulatory arrest; coagulopathy; intraoperative transesophageal echocardiography; reperfusion; thrombosis