Veno-venous extracorporeal membrane oxygenation support in the resuscitation from extreme metabolic acidosis (pH < 6.5) after drowning cardiac arrest: a case report

Yueyang Chai; Xinyi Zhang; Hong Liu

doi:10.1186/s12245-023-00501-4

Veno-venous extracorporeal membrane oxygenation support in the resuscitation from extreme metabolic acidosis (pH < 6.5) after drowning cardiac arrest: a case report

Int J Emerg Med. 2023 Apr 7;16(1):24. doi: 10.1186/s12245-023-00501-4.

Authors

Yueyang Chai^#¹, Xinyi Zhang^#², Hong Liu³

Affiliations

¹ Department of Emergency Medicine, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310006, China.
² Department of Cardiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310006, China.
³ Department of Emergency Medicine, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310006, China. 2321044@zju.edu.cn.

^# Contributed equally.

Abstract

Background: Resuscitation in drowning victim with cardiac arrest is difficult because of severe metabolic acidosis and multiple organ dysfunction. There is insufficient evidence to support that veno-venous extracorporeal membrane oxygenation (VV-ECMO) is beneficial for patient.

Case presentation: A 44-year-old female was trapped under river when she attempted to rescue her drowning father. Furthermore, she underwent a loss of consciousness, with extreme metabolic acidosis, hypothermia and hypotension. Hence, the VV-ECMO, continuous renal replacement therapy (CRRT) and other resuscitative infusion were required. In this case, the patient did not experience any complication or neurologic deficit and reaching a complete recovery after 21 days of hospitalization.

Conclusions: Our case adds further concerns in supporting a patient with extreme metabolic acidosis (pH < 6.5) and hypothermia after severe drowning cardiac arrest, including extracorporeal life support, renal support, targeted temperature management, cerebral resuscitation, etc., due to the reversible nature of this condition.

Keywords: Cerebral resuscitation; Drowning cardiac arrest (DCA); Extreme metabolic acidosis; Targeted temperature management (TTM); Veno-venous extracorporeal membrane oxygenation (VV-ECMO).