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CASE REPORT
Using an Impella device to reverse refractory cardiac arrest and enable efficient coronary revascularisation
  1. Nicolas Persico1,2,
  2. Christophe Guervilly2,3,
  3. Baptiste Verhamme1 and
  4. Laurent Bonello4
  1. 1 Emergency Department, Assistance Publique - Hôpitaux de Marseille, Marseille, France
  2. 2 CEReSS - Health Service Research and Quality of Life Center EA 3279, Aix-Marseille Université, Marseille, France
  3. 3 Réanimation des Détresses Respiratoires et des Infections Sévères, Assistance Publique - Hôpitaux de Marseille, Marseille, France
  4. 4 Department of Cardiology, Intensive Care Unit, Assistance Publique - Hôpitaux de Marseille, Marseille, France
  1. Correspondence to Dr Nicolas Persico, nicolas.persico{at}ap-hm.fr

Abstract

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.

  • interventional cardiology
  • resuscitation
  • adult intensive care
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Footnotes

  • Contributors Patient was under the care of NP, CG, BV and LB. Report was written by NP, CG, BV and LB. CG and LB revised the draft. LB supervised the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

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