22st of International Intensive Care Symposium, İstanbul, Turkey, 3 - 04 May 2019
Conference Paper / Summary Text
Case of a cardiac arrest patient who survived after extracorporeal cardiopulmonary resuscitation and 2.5 hours of resuscitationDilek AltunDepartment of Anesthesiology and Reanimation, Acıbadem Mehmet Ali Aydınlar University, Vocational School of Health Sciences, Istanbul, Turkey
Children undergoing congenital heart surgery experience a critical period of time in intensive care unit until hemodynamic stability can be achieved. Although prevention of cardiac arrest is the main goal, it is not always possible. Early institution of extracorporeal perfusion support may improve survival after cardiac arrest.
Here, we have presented the case of a 1-year-old child who survived a cardiac arrest that lasted 2½ hours. 1 year old child was admitted to our hospital for the operation of complex cardiac disease. After sucsessfully operation she was transferred to intensive care. Eight hours after operation she woke up properly with normal concious and stable hemodynamic values. After 18 hours patient became hypotensive despite normal infusions of saline solution and inotropic agents. She became progressively bradycardic, lost circulation and was found to have pulseless electrical activity. CPR was initiated. All possible reversible causes of hemodynamic collapse were evaluated, and patient was found to be in refractory cardiogenic shock.
Resuscitation was performed until ECMO could be placed. Veno-veno-arterial ECMO was started 150 minutes after the initiation of CPR, and return of spontaneous circulation was achieved 10 minutes later. In the blood gas samples K was high (K:7-9), there was deep metabolic acidosis. Peritoneal dialysis has started simultaniously.
On hospital day 5, sustaining stable hemodynamy, she was weaned from ECMO. On the 21st day surgical tracheostomy was performed. On day 55, she was transferred to the service, on 64th day she was discharged with fully normal neurological state.
Survival rate after cardiac arrest remains low, and not all patients will experience the same results as in our patient and above-mentioned case. However, we consider that documenting cases of successful prolonged resuscitation may help improve overall outcomes. We hope the case presented herein may aid in the ongoing improvement of the current CPR guidelines.
Keywords: Cardiac arrest, cardiopulmonary resuscitation, extracorporeal cardiopulmonary resuscitation, extracorporeal membrane oxygenation, complex congenital cardiac surgery