ID:165 FC-D03-1 Successful Rescue of a Newborn with Incessant Tachyarrhythmia-induced Cardiogenic Shock by Extracorporeal Membrane Oxygenation

Background: Neonatal paroxysmal supraventricular tachycardia (PSVT) can rapidly lead to hemodynamic collapse when refractory to standard therapy. In such cases, extracorporeal cardiopulmonary resuscitation (ECPR) with veno-arterial ECMO may provide temporary circulatory support while the arrhythmia is controlled. Clinical Course/Activities: A 2-day-old girl (36 + 0 weeks, 2555 g) developed persistent PSVT shortly after birth. The tachycardia was refractory to adenosine, amiodarone, propranolol, and synchronized cardioversion. She was intubated for desaturation and severe lactic acidosis, then developed bradycardia and cardiac arrest. After 17 minutes of high-quality CPR and three doses of epinephrine, ECPR was initiated. Central VA-ECMO was established via the right atrium (14 Fr) and ascending aorta (8 Fr). Sternotomy revealed poor myocardial contractility and a large patent ductus arteriosus (4 mm), which was ligated. During ECMO support, catecholamines were tapered and sinus rhythm returned. She was decannulated after three days, with sternal closure the following day. Recovery was gradual with low-dose milrinone and beta-blocker therapy. She was extubated seven days after decannulation. Neurologic evaluation and imaging showed no hypoxic-ischemic injury or intracranial hemorrhage. Echocardiography demonstrated normal ventricular function and complete PDA closure. She was discharged after 30 days with full recovery. Discussion: Early ECMO initiation stabilized circulation, reduced cardiac workload, and likely facilitated rhythm control. The witnessed arrest, prompt CPR, and reversible etiology made her an ideal ECPR candidate. Conclusion: ECPR can be lifesaving in neonatal cardiac arrest due to refractory PSVT, offering a bridge to recovery with favorable neurologic outcomes