Department of Anaesthesiology, Xuzhou Central Hospital, Xuzhou, China.
Division of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital, London, UK.
Medicine (Baltimore). 2023 Sep 29;102(39):e35226. doi: 10.1097/MD.0000000000035226.
Cardiac arrest (CA) caused by trigeminocardiac reflex (TCR) after endoscopic nasal surgery is rare. Hence, when a patient suffers from TCR induced CA in the recovery room, most doctors may not be able to find the cause in a short time, and standard cardiopulmonary resuscitation and resuscitation measures may not be effective. Providing circulatory assistance through venous-arterial extracorporeal membrane oxygenation (VA-ECMO) can help healthcare providers gain time to identify the etiology and initiate symptom-specific treatment.
We report a rare case of CA after endoscopic nasal surgery treated with VA-ECMO.
We excluded myocardial infarction, pulmonary embolism, allergies, hypoxia, and electrolyte abnormalities based on the relevant examination results. Following a multidisciplinary consultation, clinical manifestation and a review of previous literature, we reasoned that the CA was due to TCR.
VA-ECMO was established to resuscitate the patient successfully during effective cardiopulmonary resuscitation.
ECMO was successfully evacuated a period of 190 minutes of therapy. The patient was discharged home on day 8.
TCR is notable during endoscopic nasal surgery. Our case indicates that CA in operating room is worth prolonged CCPR. The ideal time for ECPR implementation should not be limited within 20 minutes after CCPR.
经内镜鼻窦手术后发生的三叉心反射（TCR）引起的心脏骤停（CA）很少见。因此，当患者在恢复室中因 TCR 引起 CA 时，大多数医生可能无法在短时间内找到原因，并且标准的心肺复苏和复苏措施可能无效。通过静脉-动脉体外膜肺氧合（VA-ECMO）提供循环辅助可以帮助医疗保健提供者争取时间来确定病因并启动针对症状的治疗。
我们报告了一例经内镜鼻窦手术后使用 VA-ECMO 治疗的罕见 CA 病例。
根据相关检查结果，我们排除了心肌梗死、肺栓塞、过敏、缺氧和电解质异常。经过多学科会诊，结合临床表现和对以往文献的回顾，我们认为 CA 是由于 TCR 引起的。
在有效的心肺复苏期间，建立 VA-ECMO 以成功抢救患者。
ECMO 成功撤离治疗 190 分钟。患者在第 8 天出院回家。
TCR 在经内镜鼻窦手术中值得注意。我们的病例表明，手术室中的 CA 值得长时间的 CCPR。实施 ECPR 的理想时间不应限于 CCPR 后 20 分钟内。
