J Extra Corpor Technol 2025 , 57 , 38 – 41 Ó The Author ( s ), published by EDP Sciences , 2025 https :// doi . org / 10.1051 / ject / 2025003
Available online at : ject . edpsciences . org
CASE REPORT
A case of intraoperative arrest & mobile ECMO
Rodrigo Alejandro Díaz Gómez ( MD ) 1 ,* , Catalina Alvarado Neves ( CCP ) 1 , Carmen Gloria Karlezi de la Fuente ( RN ) 1 , Gabriela Cecilia Bejarano Alva ( MD ) 2 , a , Dafna Garcia Gomez ( MD ) 3 , and Luisa Fernanda Rodas García ( MD ) 4 , a
1 Clinica Red Salud Santiago , Av . Libertador Bernardo O ' Higgins 4850 , Estación Central , Santiago , Región Metropolitana de Santiago , Chile 2 Hospital Regional de Moyobamba , Av . Grau Cuadra 4 , Barrio Calvario- – Moyobamba – Moyobamba , San Martín , Perú 3 Fundacion Cardiovascular de Colombia , Urbanización El Bosque . Floridablanca , Santander , Colombia 4 Instituto Guatemalteco de Seguridad Social , 7a . avenida 22-72 , zona 1 , Ciudad de Guatemala
Received 26 August 2024 , Accepted 14 January 2025
Abstract – Over the past two decades , extracorporeal membrane oxygenation ( ECMO ) has been increasingly used to support critical patients with cardiac and respiratory failure who fail to respond to conventional management . In refractory cardiac arrest , ECMO can restore perfusion in patients who meet specific criteria designed to maximize survival benefit and good neurological outcomes . In recent literature , there is no report of mobile ECMO in a case of prolonged cardiac arrest with direct cardiac massage . We describe our experience with a 34-year-old man with multiple traumatic injuries following a motor vehicle collision . He was treated in a trauma center hospital in the same city as our center . He was initially in stable condition ( spontaneous ventilation with FiO2 0.21 , no vasoactive drugs , Glasgow 15 , no acute kidney injury or other organ dysfunction ). One week after admission , a retained left hemopneumothorax required surgical intervention , as previous drainage was ineffective . Computed tomography imaging was also concerning for parencyhmal injury by the thoracotomy tube . Intraoperatively , when the patient was placed in lateral position , he experienced cardiac arrest , presumed to be secondary to pulmonary embolism . After 18 min , we were asked to rescue this patient with ECMO , as he had no contraindications to support . After 81 min of advanced life support , including direct cardiac massage , return of spontaneous circulation was achieved seconds after ECMO was initiated . He was then transported to our hospital . The patient achieved a favorable neurological outcome ( Glasgow Coma Scale score of 15 at 24 h ) and was discharged after a 2 month stay . This case highlights the potential benefits of prolonged cardiopulmonary resuscitation and ECMO in patients with refractory in-hospital cardiac arrest . In this case , proper ACLS and CPR allowed time for mobile ECMO support to be initiated from a remote center .
Key words : ECMO , ECPR , Resuscitation , Pulmonary embolism .
Overview
Even in cases occurring within hospitals , survival rates following extended cardiac arrest are low . A multicenter study examining 348,996 intra-hospital cardiac arrest ( IHCA ) incidents discovered that less than 2.5 % of patients experienced favorable outcomes after receiving CPR for over 40 min in shockable rhythm scenarios [ 1 ].
IHCA in the operating room is uncommon , occurring at a rate of 3 per 10,000 anesthetics in the UK . However , if it persists for more than 5 – 10 min , managing the situation becomes significantly more complex and often results in a poorer prognosis [ 2 ].
a ECMO program observers contributing clinically , writing and analysis of the case . Clinica Red Salud Santiago , Santiago de Chile . * Corresponding author : diazrodrigo @ me . com
To enhance survival rates and minimize neurological impairment , it is crucial to identify the issue , intervene promptly , systematically address reversible causes , and , in prolonged cases , evaluate the use of cardiopulmonary bypass ( CPB ) or ECMO in some situations , as recommended by Stanford Cognitive Aids for Perioperative Crisis guidelines [ 3 ]. However , what actions can be taken if spontaneous circulation does not resume after several minutes and ECMO or CPB are unavailable ?
In the United Kingdom , just 9 % of centers involved in analyzing intra-operative cardiac arrest ( as part of the 7th National Audit Project by the Royal College of Anaesthetists ) had ECMO available . Moreover , only 9 out of 548 patients received ECMO support [ 2 ]. A potential solution could be to activate a mobile ECMO team . A 2023 review comparing ECPR with manual or mechanical CPR during cardiac arrest found 3 trials ,
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