Pioneering Use of Extracorporeal Life Support in Intraoperative Cardiac Arrest in Dubai: A Case Report

We describe, to our knowledge, the first use in Dubai of extracorporeal life support (ECLS) in a patient who suffered intraoperative cardiac arrest due to presumed cardiac channelopathy. A 40-year-old patient presented for open myomectomy surgery. She had no other medical problems apart from obesity. The patient denied any family history of surgery or anesthesia-related complications. Her initial electrocardiogram (ECG) and laboratory results were within reference limits. Intraoperatively, the patient suffered sudden cardiac arrest, from which she was resuscitated. Point-of-care cardiac ultrasound and intensive care unit (ICU)-performed echocardiography revealed severely reduced left ventricular contractility. Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) and intra-aortic balloon pump were utilized in the immediate postoperative period. Although the patient's heart sustained more than 300 DC shocks, it recovered. Family members revealed that the patient's brother and sister had died in their 20s from sudden cardiac death. Another sister had been resuscitated a few years ago from intraoperative cardiac arrest, too. The case illustrates the importance of the patient's disclosure of relevant information. It supports the notion that ECLS can be used in the immediate postoperative period if surgical hemostasis is achieved. Controversies, such as the use of heparinization and the risk of bleeding, transthoracic echocardiography (TTE) versus transesophageal echocardiography (TEE), timely insertion of intracardiac defibrillator, and genetic screening, are discussed. A learning point is that clinicians do not work in a vacuum. Organizational leadership can greatly impact outcomes, creating conditions for safer patient care.