ECPR: When Everything Goes Right
Presenter
James Addison Burke, M.D., Ph.D., Lehigh Valley Heart Institute, Allentown, PA
James Addison Burke, M.D., Ph.D., Lehigh Valley Heart Institute, Allentown, PA
Title:
ECPR: When Everything Goes Right
Introduction
:
This case highlights the utility of ECPR in refractory cardiac arrest and the multiple steps in the ACLS Chain of Survival necessary for this therapy to succeed.
Clinical Case:
56 year old male sustained a witnessed cardiac arrest. CPR was started immediately. EMS arrived on scene in less than 10 minutes. The initial rhythm was ventricular fibrillation. He was defibrillated 3 times without success. He was
intubated. Epinephrine and amiodarone were administered but he remained in ventricular fibrillation. A LUCAS device was placed and the patient was brought to the ED with CPR ongoing. The ECPR team was notified and met the patient in the ED. Veno-Arterial ECLS was initiated followed by emergent angiography in the Cath Lab. Angiography demonstrated a proximal occlusion of a dominant circumflex. The vessel was dilated. Flow was restored and defibrillation restored a perfusing rhythm. LVEF was 20% by ventriculography. Therapeutic hypothermia was initiated and the patient transferred to the ICU. He was successfully rewarmed as per protocol, regained consciousness and was neurologically intact. He was decannulated on hospital day 3. TTE showed an improved LVEF of 50% and he was discharged on day 7.
Discussion:
V-A ECMO is a powerful tool that can support a patient in refractory cardiac arrest while other life saving measures, including angiography and PCI, can be performed. All the links in the Chain of Survival; Witnessed arrest, early CPR, ACLS, ECMO and successful PCI allowed for this patient’s successful outcome.