We present a case of a 15-year-old boy who developed pulseless electrical activity
(PEA) in the school gym, after 6-minutes ride. He received effective bystander
CPR performed by his teacher. Subsequent advanced CPR could not achieve a
sustained return of spontaneous circulation (ROSC) and refractory cardiac arrest
with PEA persisted.
On hospital arrival VA-ECMO was established during active CPR after 95 min of
cardiac arrest (time from OHCA to door: 75 min; time door to VA-ECMO: 20 min).
After starting Extracorporeal life Support (ECLS) an adequate systemic circulation
was restored and sustained ROSC was obtained. Despite the recovery of organ
perfusion, the patient showed multiple organ failure: coma, pulmonary edema,
acute renal failure, metabolic acidosis, and troponin increase. Echocardiography
showed severe left ventricle systolic dysfunction with global hypokinesia and
apparently normal coronary hosts. Under ECLS we assisted to a complete recovery
of cardiac, respiratory, and renal function. After sedation withdraw, the patient
performed simple orders without motor deficits.
An angiography CT scan, performed to evaluate the aetiology of the CA, revealed
an anomalous origin of the left coronary artery from the right coronary sinus with
severe left main stenosis. The congenital defect was surgical repaired and ECLS
maintained until full recovery (12 days). The patient was discharged in the 57th day
with a good recovery.
In refractory cardiac arrest, ECPR had several advantages, including successful
ROSC, maintain organ perfusion during recovery of native cardiac output, earn
time to perform diagnostic tests and apply surgical and medical treatments.

3 - In-Hospital Extracorporeal Cardiopulmonary Resuscitation(ECPR) after prolonged out-of-hospital cardiac arrest (OHCA). A case report