Case Report of Successful Extracorporeal CPR (eCPR) in Refractory Cardiac Arrest Caused by Fulminant Pulmonary Embolism with Remarkable Recovery
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MDPI
Abstract
Background and Clinical Significance: 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. Case Presentation: 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). Conclusions: 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.
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Except where otherwised noted, this item's license is described as Attribution 4.0 International