Emergency Medicine: Open Access
Open Access

Abstract

A Case of Successful Extracorporeal Membrane Oxygenation Support for Cardiac Arrest Associated with Nonocclusive Mesenteric Ischemia

Koichiro Ogura, Takehiko Oami, Noriyuki Hattori, Eizo Watanabe, Ryuzo Abe, Tomoaki Hashida, Takayuki Toma and Shigeto Oda

Background: We report a case of successful extracorporeal membrane oxygenation (ECMO) support for cardiac arrest associated with nonocclusive mesenteric ischemia (NOMI).
Case presentation: A 34-year-old previously healthy woman in the sixth week of her second pregnancy was carried to our hospital for abdominal pain and vomiting. She had apparent peritoneal irritation signs with marked hyperglycemia and metabolic acidosis and developed refractory shock. Since portal venous gas and intestinal dilatation without enhancement in contrast-enhanced computed tomography (CT) were observed, a subtotal resection of the small intestine and right hemicolectomy against widespread intestinal necrosis were performed as an emergency operation. The patient returned to the intensive care unit (ICU) with open abdominal management. Severe respiratory failure gradually developed during the operation, and veno-venous (V-V) ECMO was prepared to start in the ICU after the operation. However, cardiac arrest occurred abruptly during the cannulation for ECMO. Therefore, veno-arterial (V-A) ECMO was implemented and hemodynamic status gradually improved. V-A ECMO was switched to V-V ECMO on Day 4 because of persistent respiratory failure. Colostomy was performed on Day 5, abdominal wall was closed on Day 8, and ECMO was successfully weaned off on Day 9. Furthermore, several surgical interventions including gauze packing for retroperitoneal bleeding and operation for intestinal dehiscence, and right lower extremity amputation were needed. She was free from the ICU on Day 78. Finally, closure of the colostomy and anastomosis of the residual duodenum and colon were performed, and the patient was discharged from the hospital without any neurologic impairment on Day 262.
Conclusion: Successful surgical interventions and appropriate ECMO support contributed to the patient’s survival.