Bowel ischemia following extracorporeal cardiopulmonary resuscitation (ECPR): case reports and narrative review

Extracorporeal cardiopulmonary resuscitation (ECPR) is a life-saving strategy for refractory cardiac arrest (CA), but the mortality rate is still high. Bowel ischemia is associated with the clinical outcomes, and few studies on bowel ischemia following ECPR have been reported. We reported 2 cases of bowel ischemia following ECPR. And we searched literature to describe the incidence, clinical features, and outcomes of bowel ischemia following ECPR. Demographic features, risk factors, clinical features, diagnostic methods, treatment and outcome were analyzed. We described 2 patients developed bowel ischemia with recurred hematochezia at different phases post ECPR, conservative treatments were not effective, one patient received colectomy after extracorporeal membrane oxygenation (ECMO) weaning and recovered, and the other died without surgery. Our literature search found 3 publications. Non-occlusive mesenteric ischemia(NOMI) was more common for bowel ischemia following ECPR, and the incidence of NOMI in ECPR patients seemed higher than that in conventional CPR patients. Postmortem findings demonstrated signs of bowel ischemia within hours of ECPR. The incidence of bowel ischemia following ECPR could not be identified due to the variability among the studies. Bowel ischemia may initiate early post ECPR, or occur insidiously during the therapeutic process, thus clinicians should have a high suspicion and low threshold for CT scan and endoscopy. Surgical timing for advanced bowel ischemia should be individualized.