Amacher Simon A, Quitt Jonas, Hammel Eva, Zenklusen Urs, Darwisch Ayham, Siegemund Martin
Intensive Care Medicine, University Hospital Basel, Basel, Switzerland.
Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland.
Front Cardiovasc Med. 2021 Jun 24;8:707663. doi: 10.3389/fcvm.2021.707663. eCollection 2021.
We recently treated a 36-year-old previously healthy male with a prolonged hypothermic (lowest temperature 22.3°C) cardiac arrest after an alcohol intoxication with a return of spontaneous circulation after 230min of mechanical cardiopulmonary resuscitation and rewarming by veno-arterial ECMO with femoral cannulation and retrograde perfusion of the aortic arch. Despite functional veno-arterial ECMO, we continued mechanical cardiopulmonary resuscitation (Auto Pulse™ device, ZOLL Medical Corporation, Chelmsford, USA) until return of spontaneous circulation to prevent left ventricular distention from persistent ventricular fibrillation. The case was further complicated by extensive trauma caused by mechanical cardiopulmonary resuscitation (multiple rib fractures, significant hemothorax, and a liver laceration requiring massive transfusion), lung failure necessitating a secondary switch to veno-venous ECMO, and acute kidney injury with the need for renal replacement therapy. Shortly after return of spontaneous circulation, the patient was already following commands and could be discharged 3 weeks later without neurologic, cardiac, or renal sequelae and being entirely well. Prolonged accidental hypothermic cardiac arrest might present with excellent outcomes when supported with veno-arterial ECMO. Until return of spontaneous circulation, one might consider continuing with mechanical cardiopulmonary resuscitation in addition to ECMO to allow some left ventricular unloading. However, the clinician should keep in mind that prolonged mechanical cardiopulmonary resuscitation may cause severe injuries.
我们最近治疗了一名36岁、此前身体健康的男性，他在酒精中毒后发生了长时间低温性心脏骤停（最低体温22.3°C），在进行了230分钟的机械心肺复苏并通过股动脉插管和主动脉弓逆行灌注的静脉-动脉体外膜肺氧合（veno-arterial ECMO）复温后恢复了自主循环。尽管有功能性静脉-动脉体外膜肺氧合，我们仍继续进行机械心肺复苏（使用美国马萨诸塞州切尔姆斯福德市ZOLL Medical Corporation公司的Auto Pulse™设备），直到恢复自主循环，以防止持续性心室颤动导致左心室扩张。该病例因机械心肺复苏导致的广泛创伤（多根肋骨骨折、大量血胸以及需要大量输血的肝裂伤）、因肺功能衰竭而需要二次转换为静脉-静脉体外膜肺氧合以及急性肾损伤需要肾脏替代治疗而进一步复杂化。自主循环恢复后不久，患者就能对指令做出反应，并在3周后出院，没有神经、心脏或肾脏后遗症，身体完全康复。在静脉-动脉体外膜肺氧合的支持下，长时间意外低温性心脏骤停可能会有良好的预后。在恢复自主循环之前，除了体外膜肺氧合外，可能还应考虑继续进行机械心肺复苏，以实现一定程度的左心室减负。然而，临床医生应牢记，长时间的机械心肺复苏可能会造成严重损伤。
