Extracorporeal Cardiopulmonary Resuscitation: A Life-Saving Approach for Heart Transplant Recipient Patient
Mehmet Sari, Hatem Soliman-Aboumarie
Bezmialem Vakif University Dragos Hospital
Giriş: Heart transplantation is the gold standard treatment for eligible patients with end-stage heart failure (1). However, one of the primary challenges to long-term survival beyond the first year is cardiac allograft vasculopathy (CAV), also known as transplant coronary artery disease or cardiac transplant vasculopathy. Extracorporeal cardiopulmonary resuscitation (ECPR) is the use of veno-arterial extracorporeal membrane oxygenation (V-A ECMO) for patients when standard cardiopulmonary resuscitation (CPR) does not achieve a sustained return of spontaneous circulation (ROSC) within at least 20 minutes. We present our experience with ECPR in a heart transplant patient who developed cardiac arrest.
Olgu: A twenty-eight-year-old female patient, who received a heart transplant in 2016 due to dilated cardiomyopathy, was awaiting a second heart transplantation for chronic rejection. She had a history of coronary artery disease, pulmonary embolism, and four cardiac arrests in the last six months. On the 131st day of hospitalization, she developed pulseless electrical activity. After a brief resuscitation, spontaneous circulation was established, and circulatory support was provided by placing V-A ECMO cannulas. With ECMO maintaining a circulation of 3.1 L/min, the lactate level, which was 8 mMol/L in the initial blood gas. The patient, whose hemodynamic stability was achieved, was weaned off V-A ECMO on day 29.
Tartışma ve Sonuç: The main goal of ECPR is to ‘buy time’ by restoring circulation and gas exchange until definitive therapy can be administered.(2) This therapy may include percutaneous coronary intervention (PCI), recovery from cardiogenic shock, thrombectomy for massive pulmonary embolism, toxin clearance, or rewarming after hypothermic cardiac arrest.ECPR can be utilized for patients experiencing cardiac arrest both within the hospital and outside of it (OHCA). It is recommended to consider ECPR after unsuccessful conventional resuscitation efforts because organizing and preparing for ECPR takes time. ECPR Management for 'Bridge Treatment' should be kept in mind as in our case.
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