Adding Extracorporeal Membrane Oxygenation to Cardiopulmonary Resuscitation in Out-of-Hospital Cardiac Arrest Due to Pulmonary Embolism: A Case Report

We present a challenging cardiopulmonary resuscitation scenario of an out-of-hospital cardiac arrest (OHCA) in a 21-year-old healthy woman recovering from a lower limb fracture who collapsed during a rehabilitation session at a community center. The combination of witnessed arrest, administration of immediate cardiopulmonary resuscitation, and effective communication to emergency services enabled a timely cannulation of extracorporeal membrane oxygenation in a cardiopulmonary resuscitation reference center. The cause of the cardiac arrest was pulmonary embolism, and the intensive care unit team opted for thrombolysis when she arrived after 40 minutes of cardiopulmonary resuscitation. The circulatory support given by venoarterial extracorporeal membrane oxygenation enabled adequate perfusion until the restoration of cardiac blood flow at 75 minutes after cardiac arrest. Despite the initial success, several life-threatening complications occurred. Anticoagulation is of paramount importance during extracorporeal support, as is thrombolysis in massive pulmonary embolism with cardiac arrest. However, this led to several complications. We highlight the importance of liaising with a wider team in such cases, including hepatobiliary surgery, vascular surgery, and interventional radiology, as doing so saved this patient's life without deficits.