Qin Chaosheng, Jiang Yihong, Liu Jingchen, Pang Hongxuan
Department of Anesthesiology, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi 541001, People's Republic of China.
Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, People's Republic of China.
Int J Gen Med. 2021 Jan 13;14:73-76. doi: 10.2147/IJGM.S285939. eCollection 2021.
Cardiac arrest is the most serious event among the complications associated with spinal anesthesia. Spinal anesthesia reduces the release of catecholamines and impairs neuroendocrine response following cardiac arrest, which contributes cardiopulmonary resuscitation (CPR) more difficult. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) may be a bridge to provide a more effective and durable mechanical solution under this extremely critical condition. This study reports a 50-year-old man who was scheduled to undergo surgical great saphenous vein varices under spinal anesthesia. A sudden cardiac arrest occurred after spinal anesthesia. Standard CPR was performed and large doses of vascular drugs are administered, but the effect of resuscitation was still poor. We fastly initiated VA-ECMO to provide cardiopulmonary support for this refractory cardiac arrest. Fortunately, the patient was successfully resuscitated with complete recovery. In summary, standard CPR might more difficult during spinal block anesthesia. Quick-started VA-ECMO is a potential option under this situation, which protects the patient from further harm from repeated prolonged CPR, refractory hypotension and deteriorated desaturation, and therefore benefit for patient in this critical condition.
心脏骤停是脊髓麻醉相关并发症中最严重的事件。脊髓麻醉会减少儿茶酚胺的释放，并损害心脏骤停后的神经内分泌反应，这使得心肺复苏（CPR）更加困难。在这种极其危急的情况下，静脉-动脉体外膜肺氧合（VA-ECMO）可能是提供更有效、更持久机械解决方案的桥梁。本研究报告了一名50岁男性，计划在脊髓麻醉下进行大隐静脉曲张手术。脊髓麻醉后突然发生心脏骤停。进行了标准的心肺复苏，并给予了大剂量血管药物，但复苏效果仍然不佳。我们迅速启动了VA-ECMO，为这种难治性心脏骤停提供心肺支持。幸运的是，患者成功复苏且完全康复。总之，在脊髓阻滞麻醉期间，标准的心肺复苏可能会更加困难。快速启动的VA-ECMO是这种情况下的一个潜在选择，它可以保护患者免受反复长时间心肺复苏、难治性低血压和氧饱和度恶化带来的进一步伤害，因此对处于这种危急状况的患者有益。
