Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 16, 2022; 10(32): 11861-11868
Published online Nov 16, 2022. 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, Yi Jiang, Jian-Gang Zhu, Ling-Wei Zhang, Hong-Jie Tong, Peng Shen
Qian-Qian Wang, Jian-Gang Zhu, Ling-Wei Zhang, Peng Shen, Department of Intensive Care Unit, The First Hospital of Jiaxing, Jiaxing 314001, Zhejiang Province, China
Yi Jiang, Department of Osteology, The First Hospital of Jiaxing, Jiaxing 314001, Zhejiang Province, China
Hong-Jie Tong, Department of Intensive Care Unit, Affiliated Jinhua Hospital Zhejiang University School of Medicine, Jinhua 321000, Zhejiang Province, China
Author contributions: Wang QQ and Shen P served as the patient’s intensive care physicians, reviewed the literature, and contributed to manuscript drafting; Jiang Y served as the patient’s orthopedic surgeon, reviewed the literature, and contributed to manuscript drafting; Zhu JG contributed to manuscript drafting; Zhang LW analyzed and interpreted the imaging findings; Tong HJ provided guidance regarding extracorporeal membrane oxygenation procedures; All authors approved the publication of the manuscript.
Supported by The Science and Technology Project of Jiaxing, No. 2020AD30047 and No. 2019AD32231; The Key Medical Disciplines of Jiaxing, No. 04-Z-08; The Key Research Project of Zhejiang Science and Technology Department, No. 2020C03019.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Noncommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Peng Shen, MD, Chief Physician, Professor,Department of Intensive Care Unit, The First Hospital of Jiaxing, No. 1882 Zhonghuan South Road, Jiaxing 314001, Zhejiang Province, China. docshen@126.com
Received: May 29, 2022
Peer-review started: May 29, 2022
First decision: August 21, 2022
Revised: September 1, 2022
Accepted: October 13, 2022
Article in press: October 13, 2022
Published online: November 16, 2022
Processing time: 162 Days and 18.8 Hours
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: Noncardiac surgery; Extracorporeal membrane oxygenation; Cardiopulmonary resuscitation; Postoperative myocardial infarction; No heparinization; Case report

Core Tip: Cardiac arrest after noncardiac surgery has high mortality and many complications. Therefore, it is important to identify and correct a reversible etiology early. We treated a 69-year-old patient who developed cardiac arrest 2 h after lumbar disc herniation surgery. Coronary angiography under extracorporeal membrane oxygenation was performed 1 h after cardiopulmonary resuscitation, and coronary artery stenting was performed after confirming occlusion of the left anterior descending branch. The patient was finally discharged in good clinical condition. This case showed that acute myocardial infarction should be considered first, and heparin should be used cautiously in patients with early postoperative cardiac arrest.