40 R . Alejandro Díaz Gómez et al .: J Extra Corpor Technol 2025 , 57 , 38 – 41
Figure
2 . Pulmonary angiography ( 24 h after Cardiac arrest ), no pulmonary emboli was identified .
Figure 3 . Case timeline .
rhythm converted to pulseless electrical activity and kept mainly that pattern .
Echocardiography revealed enlargement of the right heart chamber , suggesting pulmonary thromboembolism . The clinical symptoms further supported this diagnosis .
Due to prolonged unresponsive cardiac arrest and the absence of ROSC , the nearest ECMO Team was contacted after 18 min of cardiac arrest . Arterial blood gas control showed metabolic acidosis ( pH 7.12 ). Considering that arrest was witnessed , initial VF rhythm , patient 0 s age , and no identifiable irreversible condition , following unsuccessful CPR , ECMO support was initiated after 81 min of uninterrupted resuscitation measures . Cannulation was performed via the right femoral vein ( 29 Fr cannula ) and the left femoral artery ( 17 Fr cannula ) with a distal reperfusion catheter ( 7 Fr ) ( Fig . 1 ). An EUROSETS ECMO Adult polymethylpentene fiber oxygenator ( Eurosets , Medolla , Italy ) and a ROTAFLOW I Centrifugal pump ( Getinge , Gothenburg , Sweden ) were used . The patient was subsequently transferred to our ECMO team center .
Mild therapeutic hypothermia was administered for 16 h and was later reversed . Upon confirmation of the neurological integrity , the patient was extubated .
After 24 h of ECMO support , pulmonary angiography excluded a massive pulmonary embolism ( Fig . 2 ). However , segmental thrombosis in the right internal saphenous vein was identified on Doppler ultrasound .
ECMO support was successfully weaned after 50 h , and an inferior vena cava filter was placed to prevent further embolization ( Fig . 3 ).
The patient was discharged from the hospital after 64 days of stance with no neurological sequelae and physical therapy to recover functional capacity .
This case report highlights the unique combination of mobile extracorporeal cardiopulmonary resuscitation ( ECPR ), direct cardiac massage and prolonged resuscitation . Successful ECPR requires a well-coordinated multidisciplinary team , optimal patient selection , adequate resources , interinstitutional collaboration and timely intervention .