1 hour of CPR, then ECMO circulation, then successful defibrillation....

An elderly woman had sudden ventricular fibrillation.She was unable to be defibrillated but was cannulated and placed on ECMO in our Emergency Department (ECLS - extracorporeal life support).  ECMO Flow was achieved after approximately 1 hour of high quality CPR.After good ECMO flow was established, she was successfully defibrillated.Here is her monitor rhythm:Notice the " Shark Fin " morphology in lead I monitor rhythm.Also notice that the arterial line mean arterial pressure is 63 mmHg, but there is no waveform (and SpO2 says " no pulse " ), as the flow is continuous on ECMO and the LV function at this point was extremely poor, unable to add a pulse pressure.She then had a 12-lead:What do you think?There is sinus bradycardia with one PVC.  There is " Shark Fin morphology "I saw this and thought for certain that this was going to be an LAD or left main occlusion as etiology of arrest, and etiology of profound ST Elevation in I, II, aVL, and V3-V6, and ST depression in III, V1 and V2.Here is a case of ECMO defibrillation with near shark fin that was due to proximal LAD occlusion.Angiography showed normal coronaries.The etiology of arrest was not determined.Troponin I rose to 44.1 ng/mL (equivalent to an hs trop I of 44,000 ng/L).  There were no further troponins, so we do not know the peak.  This is a troponin I level that is almost exclusively seen in STEMI.  In this case, profound shock for 1 hour would result in the sa...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs

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