From ECPR for refractory cardiac arrest to heart transplant and neurologically intact survival

A 58-year-old male wearing a wearable cardioverter defibrillator due to severe dilated cardiomyopathy with multi-vessel coronary disease presented a cardiac arrest (CA) with ventricular fibrillation refractory to conventional cardiopulmonary resuscitation (CPR). The decision was made to expand CPR to extracorporeal cardiopulmonary resuscitation (ECPR) using extracorporeal life support in the prehospital setting. ROSC was obtained after pump activation, and the patient was admitted to the intensive care unit, sedated and mechanically ventilated while under ECPR support. Despite an initial hemorrhagic shock due to mispositioning of the initial arterial canula requiring surgical repair, neurological evaluation was favorable and allowed for emergency heart transplantation candidacy. The patient was transplanted on day 7 after CA and discharged neurologically intact for rehabilitation on day 60. This case report shows how ECPR can be a bridge to definitive treatment if adequately integrated into an optimized out-of-hospital cardiac arrest chain of survival.