Minimizing reperfusion injuries

Successful resuscitation using eCPR after cardiac arrest on a post-operative norwood patient

Keith Amberman, Irving Shen

Research output: Contribution to journalArticle

Abstract

In patients with hypoplastic left heart syndrome (HLHS), the left ventricle is too small to circulate adequate oxygenated blood. If left untreated, HLHS is fatal. A 3-staged palliative procedure ultimately leading to a single ventricle physiology is the preferred management strategy for HLHS in most pediatric cardiac centers in the United States. In this report, a 1-month-old infant developed cardiac arrest 3 weeks after undergoing a Norwood procedure as an initial palliation for HLHS. After 151 minutes of cardio-pulmonary resuscitation (CPR) with intermittent, but non-sustainable return of spontaneous circulation, extracorporeal cardio-pulmonary resuscitation (eCPR) was used. Utilizing the carotid artery and internal jugular vein for cannulation, we connected our extracorporeal membrane oxygenation (ECMO) circuit to the patient. To minimize reperfusion injury, immediate cooling, arterial/venous shunting, minimal calcium, and hemodilution strategies were used. Once paCO 2/pvCO 2 gradients were minimized, we instituted sweep gas and gradually increased fiO 2 as pH normalized. The patient was successfully weaned from ECMO and discharged. eCPR was used successfully in the resuscitation of this patient and reperfusion injuries were minimized despite prolonged CPR.

Original languageEnglish (US)
Pages (from-to)238-241
Number of pages4
JournalJournal of Extra-Corporeal Technology
Volume42
Issue number3
StatePublished - Sep 2010
Externally publishedYes

Fingerprint

Hypoplastic Left Heart Syndrome
Cardiopulmonary Resuscitation
Heart Arrest
Reperfusion Injury
Resuscitation
Extracorporeal Membrane Oxygenation
Norwood Procedures
Hemodilution
Extracorporeal Circulation
Jugular Veins
Internal Carotid Artery
Catheterization
Heart Ventricles
Gases
Pediatrics
Calcium

Keywords

  • Extracorporeal cardiopulmonary resuscitation
  • Hypoplastic left heart syndrome
  • Ischemia/reperfusion
  • Norwood procedure
  • Pediatric
  • Reperfusion injury

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Cardiology and Cardiovascular Medicine
  • Health Professions (miscellaneous)

Cite this

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abstract = "In patients with hypoplastic left heart syndrome (HLHS), the left ventricle is too small to circulate adequate oxygenated blood. If left untreated, HLHS is fatal. A 3-staged palliative procedure ultimately leading to a single ventricle physiology is the preferred management strategy for HLHS in most pediatric cardiac centers in the United States. In this report, a 1-month-old infant developed cardiac arrest 3 weeks after undergoing a Norwood procedure as an initial palliation for HLHS. After 151 minutes of cardio-pulmonary resuscitation (CPR) with intermittent, but non-sustainable return of spontaneous circulation, extracorporeal cardio-pulmonary resuscitation (eCPR) was used. Utilizing the carotid artery and internal jugular vein for cannulation, we connected our extracorporeal membrane oxygenation (ECMO) circuit to the patient. To minimize reperfusion injury, immediate cooling, arterial/venous shunting, minimal calcium, and hemodilution strategies were used. Once paCO 2/pvCO 2 gradients were minimized, we instituted sweep gas and gradually increased fiO 2 as pH normalized. The patient was successfully weaned from ECMO and discharged. eCPR was used successfully in the resuscitation of this patient and reperfusion injuries were minimized despite prolonged CPR.",
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