PMID- 38077700
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20231211
IS  - 2284-2594 (Electronic)
IS  - 2284-2594 (Linking)
VI  - 10
IP  - 12
DP  - 2023
TI  - Never Say Never: Successful Extracorporeal Cardiopulmonary Resuscitation (ECPR) 
      Following A Prolonged Out-of-Hospital Cardiac Arrest Due to Spontaneous Coronary 
      Artery Dissection.
PG  - 004120
LID - 10.12890/2023_004120 [doi]
LID - 004120
AB  - INTRODUCTION: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) may be 
      a life-saving rescue therapy for patients with severe cardiac disease of any 
      origin and circulatory failure. Data in the literature have demonstrated that the 
      use of advanced mechanical circulation has resulted in improvements in both 
      survival and quality of life; despite this, cardiogenic shock and refractory 
      cardiac arrest remain conditions with high mortality. Opportune identification of 
      patients who can benefit from it may improve outcomes. However, the shortage of 
      guidelines on indications often results in a high mortality rate and poor 
      outcome. Due to ethical issues, randomised controlled studies with VA-ECMO have 
      not been conducted so no recommended evidence-based guidelines exist for VA-ECMO 
      patient-selection criteria. Therefore, the indications depend only on expert 
      opinion after reviewing the literature. CASE DESCRIPTION: We report the case of a 
      young female patient who presented with an out-of-hospital cardiac arrest (OHCA) 
      due to spontaneous coronary dissection. She was treated with extracorporeal 
      cardiopulmonary resuscitation (ECPR) with excellent results in terms of short and 
      long-term survival, and neurological outcome. This was despite the presence of 
      several clinical and laboratory negative prognostic factors on the basis of the 
      current literature, and the lack of general consensus among the relevant medical 
      personnel. CONCLUSION: We were able to explain the favourable outcome only on the 
      basis of clinical data. We can conclude that the availability of advanced 
      resources in the area (timeliness of the rescues, quality of the resuscitation, 
      an advanced haemodynamic management centre nearby) has contributed to determining 
      the complete clinical and neurological recovery of the patient. LEARNING POINTS: 
      Extracorporeal cardiopulmonary resuscitation to rescue patients with cardiac 
      arrest refractory to conventional cardiopulmonary resuscitation could represent a 
      life-saving technique in carefully selected patients.Refractory out-of-hospital 
      cardiac arrest with evolution to a non-shockable rhythm and severe lactic 
      acidosis are conditions that should not rule out ECPR.Evidence-based selection of 
      ECPR patients remains challenging, but it could be considered as a therapeutic 
      option in dedicated specialised centres.
CI  - (c) EFIM 2023.
FAU - Canziani, Laura
AU  - Canziani L
AD  - Department of Cardiac Annaesthesia and Intensive Care, Cardiocentro Ticino 
      Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland.
FAU - Orlando, Francesca
AU  - Orlando F
AD  - Department of Cardiac Annaesthesia and Intensive Care, Cardiocentro Ticino 
      Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland.
FAU - Villa, Michele
AU  - Villa M
AD  - Department of Cardiac Annaesthesia and Intensive Care, Cardiocentro Ticino 
      Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland.
FAU - Cassina, Tiziano
AU  - Cassina T
AD  - Department of Cardiac Annaesthesia and Intensive Care, Cardiocentro Ticino 
      Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland.
LA  - eng
PT  - Journal Article
DEP - 20231102
PL  - Italy
TA  - Eur J Case Rep Intern Med
JT  - European journal of case reports in internal medicine
JID - 101648453
PMC - PMC10705832
OTO - NOTNLM
OT  - Extracorporeal cardiopulmonary resuscitation (ECPR)
OT  - hyperlactacidemic metabolic acidosis
OT  - neurological outcome
OT  - out-of-hospital cardiac arrest (OHCA)
COIS- Conflicts of Interests: The Authors declare that there are no competing 
      interests.
EDAT- 2023/12/11 12:43
MHDA- 2023/12/11 12:44
PMCR- 2023/11/02
CRDT- 2023/12/11 06:33
PHST- 2023/09/20 00:00 [received]
PHST- 2023/10/11 00:00 [accepted]
PHST- 2023/12/11 12:44 [medline]
PHST- 2023/12/11 12:43 [pubmed]
PHST- 2023/12/11 06:33 [entrez]
PHST- 2023/11/02 00:00 [pmc-release]
AID - 4120 [pii]
AID - 10.12890/2023_004120 [doi]
PST - epublish
SO  - Eur J Case Rep Intern Med. 2023 Nov 2;10(12):004120. doi: 10.12890/2023_004120. 
      eCollection 2023.