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Case Reports
. 2022 Nov 16;10(32):11861-11868.
doi: 10.12998/wjcc.v10.i32.11861.

Survival of a patient who received extracorporeal membrane oxygenation due to postoperative myocardial infarction: A case report

Qian-Qian Wang  1 , Yi Jiang  2 , Jian-Gang Zhu  1 , Ling-Wei Zhang  1 , Hong-Jie Tong  3 , Peng Shen  4
Affiliations
Case Reports

Survival of a patient who received extracorporeal membrane oxygenation due to postoperative myocardial infarction: A case report

Qian-Qian Wang et al. World J Clin Cases. .

Abstract

Background: Cardiac arrest after noncardiac surgery is a dangerous complication that may contribute to mortality. Because of the high mortality rate and many complications of cardiac arrest, it is very important to identify and correct a reversible etiology early. By reporting the treatment process of this case, we aimed to broaden the diagnosis and treatment of cardiac arrest after noncardiac surgery and describe how cardiopulmonary resuscitation using extracorporeal membrane oxygenation (ECMO) can improve a patient's chance of survival.

Case summary: A 69-year-old man visited our hospital complaining of low back pain on July 12, 2021. Magnetic resonance imaging showed lumbar disc herniation. Two hours after lumbar disc herniation surgery, the patient developed cardiac arrest. Cardiopulmonary resuscitation was performed, and ECMO was started 60 min after the initiation of cardiopulmonary resuscitation. Regarding the etiology of early cardiac arrest after surgery, acute myocardial infarction and pulmonary embolism were considered first. Based on ultrasound evaluation, acute myocardial infarction appeared more likely. Coronary angiography confirmed occlusion of the left anterior descending branch, and coronary artery stenting was performed. Pulmonary artery angiography was performed to exclude pulmonary embolism. Due to heparinization during ECMO and coronary angiography, there was a large amount of oozing blood in the surgical incision. Therefore, heparin-free ECMO was performed in the early stage, and routine heparinized ECMO was performed after hemorrhage stabilization. Eventually, the patient was discharged and made a full neurologic recovery.

Conclusion: For early postoperative cardiac arrest, acute myocardial infarction should be considered first, and heparin should be used with caution.

Keywords: Cardiopulmonary resuscitation; Case report; Extracorporeal membrane oxygenation; No heparinization; Noncardiac surgery; Postoperative myocardial infarction.

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Conflict of interest statement

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

Figures

Figure 1
Figure 1
Magnetic resonance imaging showing disc herniations at L3/4, L4/5, and L5/S1 (arrow).
Figure 2
Figure 2
Percutaneous coronary angiography. A: Before percutaneous coronary intervention; B: After percutaneous coronary intervention.
Figure 3
Figure 3
Equipment used for extracorporeal membrane oxygenation and continuous renal replacement therapy.
Figure 4
Figure 4
The patient after successful removal of tracheal intubation.
See this image and copyright information in PMC

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