Division of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Department of Anaesthesia, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Cardiovasc J Afr. 2020 Nov-Dec;31(6):339-342. doi: 10.5830/CVJA-2020-018. Epub 2020 Jul 6.
A 28-year-old man who had a history of type 1 diabetes mellitus with poor medication compliance was referred to the emergency department of our institute with suspected diabetic ketoacidosis. The patient developed sudden cardiac arrest following continuous insulin administration. Laboratory data revealed severe hypokalaemia. Cardiopulmonary resuscitation was performed immediately for 63 minutes. Although his spontaneous circulation resumed, the haemodynamics remained unstable. Peripheral extracorporeal membrane oxygenation was therefore employed for mechanical circulatory support. Echocardiography under these conditions revealed generalised hypokinesia of the bilateral ventricles. The left ventricular ejection fraction was only 10-15%. The chest film revealed bilateral pulmonary congestion. The patient developed multiple organ dysfunction, including acute kidney injury, liver congestion and persistent pulmonary oedema, although the hypokalaemia resolved. A temporary bilateral ventricular assist device (Bi-VAD) was used for superior systemic perfusion and unloading of the bilateral ventricles after 16 hours of extracorporeal membrane oxygenation support. After the start of maintenance using the Bi-VAD, extracorporeal membrane oxygenation was discontinued and the inotropic agents were tapered down immediately. Subsequently, the haemodynamics stabilised. All the visceral organs were well perfused with Bi-VAD support. Subsequent echocardiography demonstrated recovery from the myocardial stunning, with the left ventricular ejection fraction returning to 50-60%. The Bi-VAD was gradually weaned and successfully removed 12 days after implantation. The patient had an uneventful recovery and was discharged without organ injury. Over one year of follow up in our out-patient clinic, adequate cardiac function and improved diabetes control were found.
一位 28 岁的男性，患有 1 型糖尿病，药物治疗依从性差，因疑似糖尿病酮症酸中毒被转至我院急诊科。患者在持续胰岛素输注后发生持续性心脏骤停。实验室数据显示严重低钾血症。立即进行心肺复苏 63 分钟。尽管他自主循环恢复，但血液动力学仍不稳定。因此，采用外周体外膜氧合进行机械循环支持。在这种情况下进行的超声心动图显示双侧心室普遍运动减弱。左心室射血分数仅为 10-15%。胸片显示双侧肺淤血。尽管低钾血症得到纠正，但患者仍出现多器官功能障碍，包括急性肾损伤、肝淤血和持续肺水肿。在体外膜氧合支持 16 小时后，使用临时双侧心室辅助装置（Bi-VAD）为全身灌注提供优势并减轻双侧心室的负荷。在开始使用 Bi-VAD 维持治疗后，立即停止体外膜氧合，并逐渐减少正性肌力药物。随后，血液动力学稳定。所有内脏器官在 Bi-VAD 支持下均得到良好灌注。随后的超声心动图显示心肌顿抑恢复，左心室射血分数恢复至 50-60%。Bi-VAD 逐渐脱机，植入后 12 天成功移除。患者恢复顺利，无器官损伤出院。在我们的门诊随访超过一年，发现心脏功能充足，糖尿病控制得到改善。
