Related Experiment Video
Updated: Jun 17, 2025
Standardized Model of Ventricular Fibrillation and Advanced Cardiac Life Support in Swine
Published on: January 30, 2020
Treatment of Cardiogenic Shock and Refractory Ventricular Fibrillation: Pulling Out All the Stops
Margaret Mary Glazier1, Amir Kaki2,3
1University of Galway School of Medicine, Galway, Ireland.
Insights
This case study highlights a successful treatment for acute myocardial infarction with cardiogenic shock and refractory ventricular fibrillation using extracorporeal membrane oxygenation (ECMO) and percutaneous coronary intervention. The patient experienced a full recovery, demonstrating the efficacy of this combined approach.
Area of Science:
- Cardiology
- Critical Care Medicine
- Interventional Cardiology
Background:
- Acute myocardial infarction (AMI) with cardiogenic shock and refractory ventricular fibrillation (VF) presents a critical medical emergency with high mortality.
- Prompt and aggressive management strategies are essential for improving patient outcomes in such complex cases.
Observation:
- A 62-year-old woman presented with acute inferior wall myocardial infarction, cardiogenic shock, and refractory VF.
- Mechanical circulatory support with venoarterial extracorporeal membrane oxygenation (ECMO) was initiated, followed by right heart catheterization, coronary angiography, and angioplasty.
- Therapeutic hypothermia was administered post-procedure.
Findings:
- The patient's ventricular fibrillation resolved, hemodynamic parameters stabilized (MAP >65 mmHg, PADP 10 mmHg), and left ventricular systolic function recovered completely.
- Lactate levels significantly decreased from 11.0 mmol/L to 1.2 mmol/L.
- Successful weaning from ECMO and pressor support within 24 hours of percutaneous coronary intervention, with discharge on day 6 and sustained recovery at 26-month follow-up.
Implications:
- This case demonstrates the successful application of a combined ECMO, percutaneous coronary intervention, and hypothermia protocol for managing AMI with cardiogenic shock and refractory VF.
- The presented treatment algorithm offers a favorable approach for similar high-risk cardiac emergencies.
- Early implementation of mechanical circulatory support and timely revascularization can lead to significant recovery and improved long-term prognosis.
Abstract:
We report the case of a 62-year-old woman who presented with an acute inferior wall myocardial infarction complicated by cardiogenic shock and refractory ventricular fibrillation. Following prolonged resuscitation in the emergency room, she was transferred to the cardiac catheterization laboratory where, as a first step, mechanical circulatory support with venoarterial extracorporeal membrane oxygenation (ECMO) was established. Next, a right heart catheterization study was performed, followed by coronary angiography and angioplasty of the infarct-related artery. Promptly on transfer to the intensive care unit, a hypothermia protocol was initiated. By postprocedure day 1, the patient's ventricular fibrillation had resolved, mean arterial pressure was >65 mm Hg, and pulmonary artery diastolic pressure was 10 mm Hg. Echocardiography demonstrated complete recovery of left ventricular systolic function. Lactate levels had fallen from 11.0 mmol/L (pre-ECMO) to 1.2 mmol/L. The patient was successfully weaned off pressor and ECMO support within 24 hours of the percutaneous coronary intervention procedure. She was extubated on postprocedure day 2 and discharged home on day 6. At 26-month follow-up, she remains well, angina free, neurologically intact, and without evidence of heart failure. The treatment algorithm used in this case should be considered favorably in the management of patients presenting with acute myocardial infarction complicated by cardiogenic shock and refractory ventricular fibrillation.
More Related Videos
06:10Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
07:39Use of a Percutaneous Ventricular Assist Device/Left Atrium to Femoral Artery Bypass System for Cardiogenic Shock
Published on: August 16, 2021
Related Concept Videos
01:28Disturbances in Heart Rhythm
Arrhythmias are categorized by their speed, rhythm, and origin. A slow...
01:24Blood Pressure Imbalances and Circulatory Shock
Blood Pressure: Hypertension and Hypotension
Normal blood pressure is 120/80 mm Hg. Elevated blood pressure is 120-129/under 80 mm Hg. Hypertension, warranting treatment at 130/80 mm Hg, is often asymptomatic and can lead to severe cardiovascular events, aneurysms, peripheral arterial disease, chronic renal disease, or cardiac...
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
01:26Heart Failure Drugs: Inotropic Agents
01:22Heart Failure Drugs: β-Blockers
01:24Antiarrhythmic Drugs: Class II Agents as β-Adrenergic Blockers