Redefining Limits: Extracorporeal Cardiopulmonary Resuscitation in Adult Thrombotic Thrombocytopenic Purpura

Thrombotic thrombocytopenic purpura (TTP) is a rare hematologic emergency that can rapidly progress to multiorgan failure and death if untreated. The role of extracorporeal membrane oxygenation (ECMO) in this setting is limited, and extracorporeal cardiopulmonary resuscitation (ECPR) has not been previously described. We report a case of a pregnant woman with suspected TTP who developed refractory pulseless electrical activity cardiac arrest before initiation of plasma exchange. Extracorporeal cardiopulmonary resuscitation with venoarterial ECMO was initiated despite profound thrombocytopenia (platelets 8,000/μL) as a bridge to definitive therapy, with rapid recovery of cardiac and renal function. She achieved full neurologic recovery and was discharged home without functional deficits. This case highlights the potential role of ECPR as a life-saving bridge in selected patients with TTP despite severe thrombocytopenia.