Kim Yun Seok, Choi Wookjin, Hwang Jaecheol
Department of Thoracic Surgery, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Republic of Korea.
Department of Emergency Medicine, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Republic of Korea.
Eur J Cardiothorac Surg. 2017 Jun 1;51(6):1206-1207. doi: 10.1093/ejcts/ezw413.
Extracorporeal cardiopulmonary resuscitation can be used as a rescue strategy in cases of prolonged cardiac arrest caused by massive pulmonary embolism. We present a case of a male patient who was in prolonged cardiac arrest following massive pulmonary embolism. Veno-arterial extracorporeal membrane oxygenation was initiated approximately 93 min after prolonged cardiopulmonary resuscitation. After resuscitation, bedside echocardiography and a chest computed tomography angiogram revealed a massive pulmonary embolism during extracorporeal membrane oxygenation support. The patient received transcatheter mechanical thrombectomy without haemodynamic instability in extracorporeal membrane oxygenation support. He was also treated with therapeutic hypothermia to improve neurological outcome. Renal replacement therapy for acute kidney injury was continued for 36 days. The patient was discharged at 60 days after admission with no serious complications. This case demonstrates that veno-arterial extracorporeal membrane oxygenation and therapeutic hypothermia are an effective treatment strategy for prolonged cardiac arrest caused by massive pulmonary embolism.
体外心肺复苏可作为大面积肺栓塞导致长时间心脏骤停时的一种抢救策略。我们报告一例男性患者，其在大面积肺栓塞后出现长时间心脏骤停。在长时间心肺复苏约93分钟后开始进行静脉-动脉体外膜肺氧合。复苏后，床旁超声心动图和胸部计算机断层血管造影显示在体外膜肺氧合支持期间存在大面积肺栓塞。患者在体外膜肺氧合支持下接受了经导管机械血栓切除术，且未出现血流动力学不稳定。他还接受了治疗性低温治疗以改善神经功能结局。针对急性肾损伤的肾脏替代治疗持续了36天。患者入院60天后出院，无严重并发症。该病例表明，静脉-动脉体外膜肺氧合和治疗性低温是治疗大面积肺栓塞所致长时间心脏骤停的有效治疗策略。
