From ECPR for refractory cardiac arrest to heart transplant and neurologically intact survival

Area of Science:

• Cardiology
• Emergency Medicine
• Cardiovascular Surgery

Background:

• Severe dilated cardiomyopathy and multi-vessel coronary disease pose significant risks for cardiac arrest.
• Conventional cardiopulmonary resuscitation (CPR) may be insufficient for refractory ventricular fibrillation.

Purpose of the Study:

• To report a case of successful prehospital extracorporeal cardiopulmonary resuscitation (ECPR) in a patient with refractory cardiac arrest.
• To demonstrate ECPR as a viable bridge to definitive treatment, including heart transplantation.

Main Methods:

• Prehospital ECPR initiation using extracorporeal life support for refractory ventricular fibrillation after cardiac arrest.
• Management in the intensive care unit under ECPR support, including addressing complications like hemorrhagic shock.
• Evaluation for and subsequent emergency heart transplantation.

Main Results:

• Return of spontaneous circulation (ROSC) was achieved after ECPR initiation.
• The patient, despite initial complications, had favorable neurological evaluation and became a candidate for heart transplantation.
• Successful heart transplantation was performed on day 7, with the patient discharged neurologically intact on day 60.

Conclusions:

• ECPR can be a critical bridge to definitive treatment in select out-of-hospital cardiac arrest cases.
• Successful integration of ECPR into the chain of survival can improve outcomes for patients with complex cardiac conditions.
• This case highlights the potential of advanced extracorporeal support in prehospital settings for achieving recovery and definitive therapy.