Extracorporeal Cardiopulmonary Resuscitation in a 36-Year-Old Man with Viral Myocarditis Who Survived Prolonged Cardiac Arrest and Bedside Decompressive Laparotomy Neurologically Intact

Abstract

Introduction: We report a case of prolonged cardiac arrest in a patient with viral myocarditis who was subsequently cannulated for Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO). The patient developed bowel ischemia and abdominal compartment syndrome on ECMO and required a bedside decompressive laparotomy and hemicolectomy. Case: A 36-year-old-man with refractory pulseless ventricular tachycardia following a viral syndrome was transferred to the cardiovascular intensive care unit, where he then required VA-ECMO in an emergent fashion at the bedside. The patient was in cardiac arrest for 105 minutes before being cannulated for VA-ECMO. He required inotropic support and temporary transvenous pacing. Subsequently, on ECMO day three, the patient developed abdominal compartment syndrome requiring bedside decompressive laparotomy with temporary abdominal closure and end ileostomy. The patient had other sequela of ischemia to the right hand and bilateral lower extremities requiring bilateral below-knee amputations. He had no native cardiac activity for approximately one week, but then developed native cardiac function with an ejection fraction of 50%. After decannulation, the patient was discharged to a rehabilitation facility neurologically intact. Conclusion(s): Patients who receive high quality CPR and have a witnessed arrest with reversible cause can be considered for extracorporeal cardiopulmonary resuscitation (eCPR) even with a prolonged low flow state. Early recognition of abdominal compartment syndrome with rapid intervention also led to patient survival in this case. Though prolonged cardiac arrest and bowel ischemia requiring emergent laparotomy are independently associated with poor survival, we present a case of a patient who survived to discharge neurologically intact.