Neurologically Intact Recovery After Extracorporeal Cardiopulmonary Resuscitation for Cardiac Arrest Due to Blow-Out-Type Left Ventricular Free Wall Rupture: A Case Report

Blow-out-type left ventricular free wall rupture after acute myocardial infarction is a catastrophic complication that often causes cardiac arrest.Neurologically intact survival after extracorporeal cardiopulmonary resuscitation is rare, particularly when extracorporeal support must be established outside a catheterization laboratory.We report a patient who survived neurologically intact despite the initiation of venoarterial extracorporeal membrane oxygenation without fluoroscopic guidance and with markedly limited blood flow.A 74-year-old woman with acute myocardial infarction developed cardiac arrest due to blow-out-type left ventricular free wall rupture while awaiting emergency coronary angiography.Cardiopulmonary resuscitation was initiated immediately, and venoarterial extracorporeal membrane oxygenation was established by femoral cannulation without fluoroscopic guidance 16 min after cardiac arrest.Cardiac tamponade limited extracorporeal blood flow to approximately 1.5 L/min.She was transferred directly to the operating room, where blow-out rupture of the left ventricular apex was confirmed.After conversion to cardiopulmonary bypass, the rupture was repaired with felt strips, and coronary artery bypass grafting to the left anterior descending artery was performed using a saphenous vein graft.She regained consciousness without apparent neurological deficits, was extubated on postoperative day three, and was transferred to a rehabilitation hospital on postoperative day 49.At 12 months, she remained clinically well.Rapid diagnosis, extracorporeal cardiopulmonary resuscitation, and immediate surgical repair may enable neurologically intact survival after cardiac arrest caused by blow-out-type left ventricular free wall rupture.