Use of ECMO (Extracorporeal Membrane Oxygenation) in Cardiac Arrest during Spinal Anesthesia - A case report -

We experienced a case where extracorporeal membrane oxygenation ECMO was used for a cardiac arrest that occurred during spinal anesthesia. An 84-year-old man underwent total hip replacement surgery. The patient developed sudden cardiac arrest at around 40 minutes after the administration of spinal anesthesia. The cardiac arrest was difficult to manage with ordinary CPR (cardiopulmonary resuscitation) and went on to complete cardiac arrest. ECMO (venoarterial ECMO from the right femoral artery to the right femoral vein) was immediately applied while performing cardiac massage. Heparin was infused with ACT (activated coagulation time) monitoring during ECMO. We also found multiple rib fractures and hemothorax resulting from the chest massage as seen on a chest X-ray. On the third day after resuscitation, communication with the patient was possible. Hemodialysis was performed due to acute renal failure on the same day. On the seventh day, the vital signs became stable. The flow of the pump was lowered and the patient was weaned from ECMO. However, the patient could not be weaned from ventilatory support due to the hemothorax caused by the CPR. Thereafter, weaning from ventilatory support was delayed due to a decline of pulmonary function. The patient organ functions (kidney, lung, liver, heart) were gradually getting worse. The patient expired due to multiple organ failure on day 92. ECMO can be considered in case of cardiac arrest due to reversible causes. (Korean J Anesthesiol 2007; 53: 785～90)