E-CPR: coming back to life

Area of Science:

• Pediatric Cardiology
• Cardiovascular Surgery
• Critical Care Medicine

Background:

• Anomalous left coronary artery from the pulmonary artery (ALCAPA) can cause severe left ventricular dysfunction.
• Surgical correction of ALCAPA is complex and carries risks of postoperative complications.
• Cardiac arrest post-extubation in pediatric cardiac surgery requires rapid and effective resuscitation strategies.

Observation:

• A 3.5-month-old infant with ALCAPA experienced cardiac arrest after surgical correction and extubation.
• Conventional cardiopulmonary resuscitation (CPR) was ineffective.
• Extracorporeal cardiopulmonary resuscitation (E-CPR) using venoarterial extracorporeal membrane oxygenation (VA-ECMO) was initiated after 70 minutes.

Findings:

• E-CPR provided hemodynamic stability and maintained end-organ function for 72 hours and 45 minutes.
• The patient demonstrated significant recovery post-decannulation, with normal neurological status and improved cardiac function.
• At 6 months post-discharge, left ventricular function normalized.

Implications:

• E-CPR is a viable rescue therapy for refractory cardiac arrest in pediatric patients with complex congenital heart disease.
• Early initiation of E-CPR can improve outcomes in severe post-cardiac surgery complications.
• Successful E-CPR may facilitate recovery of myocardial function in pediatric ALCAPA patients.