Survival after extracorporeal cardiopulmonary resuscitation for adolescent arrhythmogenic arrest: ECPella (extracorporeal membrane oxygenation with Impella^®)-a case report

Background: The combined therapy with venoarterial extracorporeal membrane oxygenation and Impella (ECPella) has been shown to improve survival in acute cardiogenic shock (CS) in adult patient. Only three paediatric cases have been reported in a multicentre study.

Case summary: We present our case, the first described to our knowledge in the UK, of a 15-year-old adolescent of Afro-Caribbean descent, weight 75 kg, who received extracorporeal cardiopulmonary resuscitation (E-CPR) and ECPella implantation. The patient suffered a sudden cardiac arrest at home; his mother called for an ambulance that arrived within 10 min and commenced life support with a LUCAS device. He received three doses of adrenaline and three desynchronized shocks for an underlying rhythm of ventricular fibrillation (VF) after which return of spontaneous circulation was achieved. He was then transferred to his local hospital where he had another VF arrest with successful cardioversion and was then transferred to our institution where on arrival he had another VF arrest and received E-CPR and ECPella implantation under the institutional adult shock programme within 3 h of in-hospital cardiac arrest. Following weaning from ECPella, the patient underwent cardiac and brain magnetic resonance imaging and serial echocardiograms with complete recovery of ventricular function. After implantation of cardiac defibrillator, he was discharged home without neurological sequelae. He remains asymptomatic from a cardiac perspective, with a normal cardiac examination and with no neurological sequelae at 2-year follow-up.

Discussion: This is the first case description of ECPella use in a child in the UK and highlighted the importance of timely institution of E-CPR on survival benefit in fatal CS. The outcome success of post-resuscitation ECPella strategy in this adolescent was through collaborative interprofessional engagement of multiple supra-specialists within acute cardiology and critical care across paediatric and adult services and alignment with the institutional adult shock programme.