Feasibility of extracorporeal life support in cardiopulmonary resuscitation technique in cardiac patients (clinical case)
https://doi.org/10.33667/2078-5631-2020-13-48-51
Abstract
Objective. To present our clinical case of extracorporeal life support using a standard oxygenator in a patient undergoing cardiac surgery when standard cardiopulmonary resuscitation (CPR) turned out to be ineffective. Methods. The response to treatment of patient G. aged 49 years is presented here who initially underwent off-pump mammary coronary artery bypass grafting (1-CABG) with left internal thoracic artery to the anterior interventricular artery without any technical peculiarities. 8 hours after the surgery a cardiac arrest occurred with the patient in the intensive care unit (ICU). Resuscitation measures resulted in no response. CPB machine was connected as part of cardiopulmonary resuscitation complex (CPR). Standard oxygenator (Medtronic Affinity NT) equipped with a set of standard lines was used for a circulatory support. Result. At ICU emergency resternotomy was performed and CPB machine was connected as well. It took 26 minutes from the beginning of resuscitation to the extracorporeal circulation. CPB machine was connected centrally (ascending aorta to the right atrium). Against the ongoing extracorporeal life support the patient was transported to the x-ray operating theatre for emergency coronary bypass angiography during which pronounced native coronary artery spasm in all basins was diagnosed; intra-aortic balloon pump was used. The cardiac activity was restored. Reperfusion took 128 minutes. Extracorporeal circulation was stopped when 5 mcg/ kg/min. dopamine infusion and nitroglycerin used at a dose of 1 mcg/kg/min. ensured satisfactory hemodynamic parameters. The extracorporeal circulation lasted for 185 minutes. The patient spent three days at the ICU and was discharged on the 11th day after the surgery has been performed in a satisfactory condition with no neurologic impairment; at discharge the left ventricular ejection fraction (LVEF) by Simpson was 60 %. Conclusion. The extracorporeal life support as part of CPR in cardiac patients can contribute to the reduction of mortality for the described patient cohort.
About the Authors
V. V. Bazylev
Federal Centre for Cardiovascular Surgery
Russian Federation
Penza
Russian Federation
Penza
M. E. Evdokimov
Federal Centre for Cardiovascular Surgery
Russian Federation
Penza
Russian Federation
Penza
M. A. Pantiukhina
Federal Centre for Cardiovascular Surgery
Russian Federation
Penza
Russian Federation
Penza
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Review
For citations:
Bazylev V.V., Evdokimov M.E., Pantiukhina M.A. Feasibility of extracorporeal life support in cardiopulmonary resuscitation technique in cardiac patients (clinical case). Medical alphabet. 2020;(13):48-51. (In Russ.) https://doi.org/10.33667/2078-5631-2020-13-48-51
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