Cardiac Arrest and Successful Extracorporeal Cardiopulmonary Resuscitation as a Result of a Refeeding Syndrome in a Young Female with Anorexia Nervosa

Abstract

Anorexia nervosa is a potentially life-threatening eating disorder, characterized by an abnormally low body weight. This case report illustrates a 22-year old female with cardiac arrest due to a refeeding syndrome in a patient with anorexia nervosa. It features the successful use of extracorporeal cardiopulmonary resuscitation in a case of severe left ventricular dysfunction resulting in a favorable outcome. Conclusion. We present the first case of a cardiac arrest due to a refeeding syndrome in anorexia nervosa featuring the successful use of an extracorporeal cardiopulmonary resuscitation approach as a bridge to full recovery.

Neurological Resilience in Patients With Anorexia Nervosa Following Prolonged Cardiopulmonary Resuscitation

“…In another report, a 33-year-old patient with AN had a cardiac arrest due to left ventricular dysfunction during hospitalization and recovered after immediate ECMO [ 6 ]. In comparison to the cases, the patient in this study had an even longer duration of CPR (Table 1 ) [ 5 - 8 ].…”

“…Favorable outcomes in AN patients with shorter resuscitation times have been reported previously where a 22-year-old patient with AN with ventricular fibrillation due to refeeding syndrome was saved after 45 minutes of CPR followed by ECMO. Her cardiac function recovered with no neurological sequelae [ 5 ]. In another report, a 33-year-old patient with AN had a cardiac arrest due to left ventricular dysfunction during hospitalization and recovered after immediate ECMO [ 6 ].…”

“…Half of the cardiac arrests in AN cases have been reported to be due to suicide, whereas the majority of the remaining cases are associated with fatal arrhythmias and refeeding syndromes [ 4 ]. However, there are only a few reports of patients with AN who have been resuscitated after cardiac arrest [ 5 , 6 ].…”

Cardiac Failure Requiring Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) Management in a Refeeding Syndrome Patient with Diabetic Ketoacidosis: A Case Report

“…Since VA-ECMO was withdrawn after 4 days in our case, the stunned myocardium was believed to have been background pathophysiology. There is only one previous report of introduction of VA-ECMO for cardiac failure due to RFS [ 7 ], and that report also suggested the need for extracorporeal support for treatment of the cardiac failure caused by RFS.…”

神経性食思不振症による心停止に対しV–A ECMOを使用した1例〜栄養障害による痩せへの蘇生とその注意点〜(Use of veno–arterial extracorporeal membrane oxygenation in cardiac arrest due to anorexia nervosa: A case report – Notes on resuscitations –)

“…神経性食思不振症は自己の身体像の歪曲から摂食障害を来す疾患であり，若年の女性に多い。精神科領域で取り扱う疾患のなかで神経性食思不振症は最も死亡率が高く 1)，年々発症が増えていることから社会的な問題となっている。神経性食思不振症による死亡原因の多くは突然の致死性不整脈，飢餓，または自殺である。神経性食思不振症が引き起こす致死性不整脈は低カリウム血症や低マグネシウム血症などの電解質異常，低血糖，心機能低下，refeeding syndromeなど多因子によってもたらされる。このため致死性不整脈から心停止となった場合には心肺蘇生法への抵抗性が危惧される。一般的に治療に難渋する心停止に対してveno–arterial extra corporeal membrane oxygenation（V–A ECMO）が行われることがある 2)が，神経性食思不振症に起因する心停止に対してV–A ECMOを使用したのは2023年12月現在，PubMedおよび医学中央雑誌における検索では2例のみであった 3), 4)。Waddellら 3)によると若年女性が神経性食思不振症からrefeeding syndromeを来し心停止になったが，45分間の心肺蘇生では自己心拍が得られずV–A ECMOを導入し予後良好な経過をたどったと報告している。今回我々は，神経性食思不振症の治療中に心室頻拍から心停止となった症例に対し，通常の蘇生に抵抗を示したためV–A ECMOを導入し救命した1例を経験した。この症例から神経食思不振症に対する心肺蘇生に対し注意点が判明したので報告する。…”