Emergency Cardiopulmonary Bypass for Prolonged Cardiac Arrest During Hepatic Resection

To the Editor: We report a case of successful resuscitation using emergency percutaneous cardiopulmonary bypass (emergency bypass) during noncardiac surgery. Approximately 1 h into a hemi-hepatectomy, during portal vein dissection, there was sudden onset of hypotension and tachycardia, followed by electromechanical dissociation and subsequent ventricular fibrillation. The presumed diagnosis was gas embolism. Ventricular fibrillation was resistant to advanced cardiac life support, and so emergency bypass was established. During the first 30 min of bypass, an amiodarone infusion was started and plasma electrolyte abnormalities were corrected. The patient spontaneously reverted to a supraventricular rhythm and later to sinus rhythm. Apart from renal impairment, the patient recovered well. The indications for emergency bypass in cardiac arrest include reversible conditions such as hypothermia, drug toxicity, and pulmonary embolism (likely in this case) (1–3). Many anesthesiologists, particularly those not routinely involved with cardiac surgery, may not think to use emergency bypass. Perioperative reports of emergency bypass in noncardiac surgery have involved cardiac arrest associated with local anesthetic toxicity (4). Survival may increase if emergency bypass is instituted within 30 min from the initial cardiac arrest (1). Because intraoperative cardiac arrests are witnessed events, in the operating room, emergency bypass can be considered in cases of cardiac arrest resistant to conventional advanced life support (1,5). Taidi Zhong, MD Chunyan Yan, MD Department of Anaesthesia Sir Run Run Shaw Hospital Hangzhou, China David A. Story, MD, FANZCA Department of Anaesthesia Austin Hospital Heidelberg, Victoria, Australia [email protected]