Harbaum Lukas, Mihali Klevis, Ausbüttel Felix, Schieffer Bernhard, Kreutz Julian
Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital, Philipps Universität Marburg, 35043 Marburg, Germany.
Reports (MDPI). 2025 Jun 25;8(3):100. doi: 10.3390/reports8030100.
: Fulminant pulmonary embolism (PE) leading to an out-of-hospital cardiac arrest (OHCA) is associated with a high mortality rate and cardiopulmonary resuscitation (CPR) frequently failing to achieve return of spontaneous circulation (ROSC). Extracorporeal CPR (eCPR) has emerged as a potential life-saving intervention. : A 66-year-old woman suffered an OHCA due to massive PE, presenting with pulseless electrical activity (PEA). After 90 min of pre- and in-hospital CPR without sustained ROSC, venoarterial extracorporeal membrane oxygenation (va-ECMO) was initiated as eCPR upon arrival at the hospital. Even after implantation of the va-ECMO, there was initially a pronounced acidosis (pH 6.9) with a high elevated lactate level (>30 mmol/L); these factors, together with the prolonged low-flow period, indicated a poor prognosis. Further diagnostic tests revealed intracranial hemorrhage (subdural hematoma), and systemic lysis was not possible. With persistent right heart failure, surgical thrombectomy was performed during hospitalization. Intensive multidisciplinary management finally led to successful therapy and weaning from mechanical ventilation, as well as to complete neurological recovery (CPC-Score 1-2). : This case illustrates that eCPR can facilitate survival with good favorable neurological outcomes despite initially poor prognostic predictors. It underscores the importance of refining patient selection criteria and optimizing management strategies for eCPR in refractory cardiac arrest secondary to PE.
暴发性肺栓塞（PE）导致院外心脏骤停（OHCA）与高死亡率相关，且心肺复苏（CPR）常常无法实现自主循环恢复（ROSC）。体外心肺复苏（eCPR）已成为一种潜在的挽救生命的干预措施。一名66岁女性因大面积PE发生OHCA，表现为无脉电活动（PEA）。在进行90分钟的院前和院内CPR后仍未实现持续ROSC，入院后启动静脉-动脉体外膜肺氧合（va-ECMO）作为eCPR。即使植入va-ECMO后，最初仍存在明显的酸中毒（pH 6.9）且乳酸水平显著升高（>30 mmol/L）；这些因素连同长时间的低流量期提示预后不良。进一步的诊断检查发现颅内出血（硬膜下血肿），无法进行全身溶栓。由于持续存在右心衰竭，住院期间进行了手术取栓。强化的多学科管理最终带来了成功的治疗以及脱机，还有完全的神经功能恢复（CPC评分1-2）。该病例表明，尽管最初预后预测指标不佳，但eCPR可促进患者存活并获得良好的神经功能结局。它强调了完善PE继发难治性心脏骤停患者的eCPR患者选择标准和优化管理策略的重要性。
