Open AccessUsing an Impella device to reverse refractory cardiac arrest and enable efficient coronary revascularisation
Author(s) -
Nicolas Persico,
Christophe Guervilly,
Baptiste Verhamme,
Laurent Bonello
Publication year - 2019
Publication title -
bmj case reports
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.231
H-Index - 26
ISSN - 1757-790X
DOI - 10.1136/bcr-2019-230654
Subject(s) - medicine , impella , extracorporeal membrane oxygenation , cardiology , cardiogenic shock , ejection fraction , myocardial infarction , ascending aorta , refractory (planetary science) , coronary artery disease , heart failure , aorta , physics , astrobiology
We report the case of a 54-year-old man who suffered from refractory cardiac arrest secondary to acute myocardial infarction. As veno-arterial extracorporeal membrane oxygenation was unavailable, mechanical chest compression was performed and an Impella device was used that immediately delivered at 3.2 l/min flow to reach the optimal mean arterial pressure. Within 1 min, return of spontaneous circulation was achieved and a 40% left ventricular ejection fraction was measured on echography. Then, the right coronary artery could be revascularised. Despite 62 min low flow, the patient was discharged home on day 19 without neurological sequelae. During refractory cardiac arrest, the European Resuscitation Guidelines indicate that veno-arterial extracorporeal membrane oxygenation should be considered as rescue therapy. Other mechanical circulatory supports such as an Impella device (left ventricular assist device propelling blood in the ascending aorta) can be a promising treatment in select patients; however, insufficient data in humans are available.