Department of Emergency Medicine, Changhua Christian Hospital, Changhua, Taiwan.
Department of Emergency Medicine, Changhua Christian Hospital, Changhua, Taiwan; Department of Mechanical Engineering, Chung Yuan Christian University, Taoyuan, Taiwan.
Am J Emerg Med. 2019 Mar;37(3):560.e1-560.e4. doi: 10.1016/j.ajem.2018.11.020. Epub 2018 Nov 16.
Refractory ventricular fibrillation with cardiac arrest caused by occlusion of the left main coronary artery may rapidly become fatal. In this report, we describe the case of a 70-year-old male who presented to emergency department with chest pain. Electrocardiogram showed ST-segment elevation in leads aVR and aVL and ST-segment depression in leads v3, v4, v5, v6, 2, 3, and aVF. Occlusion of the left main coronary artery was suspected. While waiting for percutaneous coronary intervention, the patient experienced sudden refractory ventricular fibrillation with cardiac arrest. In the emergency department, resuscitation of a patient with refractory ventricular fibrillation caused by occlusion of the left main coronary artery and ongoing cardiopulmonary resuscitation is a clinical challenge. Resuscitation with extracorporeal membrane oxygenation support was initiated approximately 35 min after prolonged conventional cardiopulmonary resuscitation. Emergency coronary angiography showed almost total occlusion of the left main coronary artery. Percutaneous coronary intervention with a stent restored coronary perfusion. The patient was discharged on day 6 without serious sequelae or neurological deficits.
左主干冠状动脉闭塞引起的难治性心室颤动伴心搏骤停可能迅速致命。本报告描述了一位 70 岁男性的病例，他因胸痛到急诊科就诊。心电图显示 aVR 和 aVL 导联 ST 段抬高，v3、v4、v5、v6、2、3 和 aVF 导联 ST 段压低。怀疑左主干冠状动脉闭塞。在等待经皮冠状动脉介入治疗期间，患者出现难治性心室颤动伴心搏骤停。在急诊科，对左主干冠状动脉闭塞引起的难治性心室颤动伴心搏骤停患者进行复苏以及持续心肺复苏是一项临床挑战。在长时间常规心肺复苏后约 35 分钟开始进行体外膜氧合支持复苏。急诊冠状动脉造影显示左主干冠状动脉几乎完全闭塞。经皮冠状动脉介入治疗置入支架恢复冠状动脉灌注。患者于第 6 天出院，无严重后遗症或神经功能缺损。
