Cardiac arrest in pregnancy with successful stabilization and delivery on veno-arterial extracorporeal membrane oxygenation: a case report.

IF 0.8 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS
European Heart Journal: Case Reports Pub Date : 2024-10-17 eCollection Date: 2024-11-01 DOI:10.1093/ehjcr/ytae551
Alice Burton, Seshika Ratwatte, David Zalcberg, Matthew Morgan, Rajit Narayan, Rachael Cordina
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Abstract

Background: Cardiac arrest in pregnancy is rare. Clinicians need to adapt management to the altered anatomy and physiology of pregnancy, and the well-being of two patients (mother and foetus) may come into consideration. The medical literature has limited reports on outcomes following extracorporeal membrane oxygenation (ECMO) in pregnancy.

Case summary: We report the evaluation, management, and outcome of a woman with cardiac arrest and severe left ventricle (LV) dysfunction in mid-trimester of pregnancy. The previously well woman had tolerated two prior term pregnancies without complication. At 25 weeks of gestation, she presented to the hospital with breathlessness and vomiting after a pre-syncopal episode at home. She then had in-hospital cardiac arrest, managed initially with cardiopulmonary resuscitation. The LV was dilated, thin walled, and severely impaired (LV ejection fraction 14%), and there was a secundum atrial septal defect (ASD). She was supported with veno-arterial ECMO. Planned birth occurred 5 days post-arrest for maternal indication. Coronary angiography demonstrated 99% proximal left anterior descending artery stenosis and aneurysm, raising the possibility of previous subclinical Kawasaki disease. She underwent surgical revascularization and ASD closure. Both mother and infant made a good recovery.

Discussion: We report a case of cardiac arrest in pregnancy as first presentation of severe LV dysfunction. The case highlights the role of ECMO for cardiac arrest in pregnancy and outlines specific interventions and management concepts in this setting.

妊娠期心脏骤停,经静脉-动脉体外膜氧合成功稳定并分娩:病例报告。
背景:妊娠期心脏骤停十分罕见。临床医生需要根据妊娠期的解剖和生理变化调整治疗方法,同时还要考虑两名患者(母亲和胎儿)的福祉。医学文献中关于妊娠期体外膜肺氧合(ECMO)术后结果的报道有限。病例摘要:我们报告了一名妊娠中期心脏骤停并伴有严重左心室(LV)功能障碍的妇女的评估、管理和结果。这位孕妇之前两次足月妊娠均无并发症发生。妊娠25周时,她在家中突发晕厥前兆,随后因呼吸困难和呕吐到医院就诊。随后,她在院内心脏骤停,最初是通过心肺复苏术进行处理。她的左心室扩张、薄壁、严重受损(左心室射血分数为14%),并且存在房间隔缺损(ASD)。她接受了静脉-动脉 ECMO 支持。由于产妇的适应症,她在心跳停止后 5 天按计划分娩。冠状动脉造影显示,99%的左前降支动脉近端狭窄和动脉瘤,可能曾患有亚临床川崎病。她接受了血管重建手术和 ASD 闭合术。母婴均恢复良好:我们报告了一例以严重左心室功能障碍为首发症状的妊娠期心脏骤停病例。本病例强调了 ECMO 在妊娠期心脏骤停中的作用,并概述了在这种情况下的具体干预措施和管理理念。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
European Heart Journal: Case Reports
European Heart Journal: Case Reports Medicine-Cardiology and Cardiovascular Medicine
CiteScore
1.30
自引率
10.00%
发文量
451
审稿时长
14 weeks
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