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Beyond the limits - ECPR in putative fatal circumstances
Ingo Graeff1, Sylvia Schacher1, Stefan Lenkeit2
1*Emergency Department,University Hospital Bonn,Bonn,Germany.
CJEM
|March 26, 2018
Summary
Extracorporeal cardiopulmonary resuscitation (ECPR) may be warranted in select hypothermic cardiac arrest patients, even with severe indicators. This case demonstrates survival with good neurological outcome despite initially poor prognostic factors.
Area of Science:
- Emergency Medicine
- Cardiology
- Critical Care Medicine
Background:
- Extracorporeal cardiopulmonary resuscitation (ECPR) eligibility criteria for cardiac arrest patients remain unclear.
- Current guidelines from the European Resuscitation Council (ERC) and American Heart Association (AHA) offer limited specific guidance for hypothermic cardiac arrest.
Observation:
- A case of unwitnessed out-of-hospital cardiac arrest in a patient found with head immersed in cold water (23°C).
- The patient presented with asystole, severe acidosis (pH 6.8), hyperkalemia (8.3 mmol/L), and high lactate (16.0 mmol/L).
Findings:
- Despite dire prognostic indicators and prolonged cardiopulmonary resuscitation (CPR) of 95 minutes, ECPR was initiated.
- The patient survived the ECPR procedure with a favorable neurological outcome.
Implications:
- This case underscores the uncertainty in ECPR eligibility and prognostication, particularly in hypothermic drowning victims.
- Aggressive therapies like ECPR may be beneficial in selected cases of hypothermic cardiac arrest, warranting further investigation.
- Improved strategies are needed to better define candidacy for resource-intensive procedures like ECPR.
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