Early initiation of venovenous ECMO for drowning-associated refractory hypoxemia after cardiac arrest: a case report

BACKGROUND: Drowning-associated cardiac arrest is associated with high mortality and poor neurological outcomes. The appropriate prognosis prediction and determination of a treatment plan are crucial. CASE PRESENTATION: A 19-year-old Japanese male was playing in a river. His friend found him drowning and immediately pulled him out. He experienced cardiac arrest. His friend called for emergency services and performed bystander cardiopulmonary resuscitation. When the emergency service later arrived at the scene, the patient was in a state of return of spontaneous circulation. The patient was transported to our hospital by air ambulance. He was subsequently admitted to the intensive care unit and later discharged without residual higher brain dysfunction as a result of multidisciplinary treatment, including venovenous extracorporeal membrane oxygenation (V-V ECMO). CONCLUSIONS: In drowning-associated cardiac arrest with rapidly progressive hypoxemia, early initiation of V-V ECMO as part of comprehensive post-cardiac arrest management may contribute to favorable neurological outcomes.