Prolonged Intraoperative Cardiac Resuscitation Complicated by Intracardiac Thrombus in a Patient Undergoing Orthotopic Liver Transplantation

Abstract

We report the case of successful resuscitation after prolonged cardiac arrest during orthotopic liver transplantation. After reperfusion, the patient developed ventricular tachycardia, complicated by intracardiac clot formation and massive hemorrhage. Transesophageal echocardiography demonstrated stunned and nonfunctioning right and left ventricles, with developing intracardiac clots. Treatment with heparin, massive transfusion and prolonged cardiopulmonary resuscitation ensued for 51 minutes. Serial arterial blood gases demonstrated adequate oxygenation and ventilation during cardiopulmonary resuscitation. Cardiothoracic surgery was consulted for potential use of extracorporeal membrane oxygenation, however, the myocardial function improved and the surgery was completed without further intervention. On postoperative day 6, the patient was extubated without neurologic or cardiac impairment. The patient continues to do well 2 years posttransplant, able to perform independent daily activities of living and his previous job. This case underscores the potential for positive outcomes with profoundly prolonged, effective advanced cardiovascular life support in patients who experience postreperfusion syndrome.

Meet the Demand

“…Dr Kim and his group wrote a case report entitled "Prolonged Intraoperative Cardiac Resuscitation Complicated by Intracardiac Thrombus in a Patient Undergoing Orthotopic Liver Transplantation." 14 This report of successful resuscitation after prolonged cardiac arrest during orthotopic liver transplantation highlights the role of effective cardiopulmonary resuscitation even when it is prolonged, in patients who experience post-reperfusion syndrome after liver transplantation.…”

Role of Transesophageal Echocardiography in the Diagnosis of Multi-chamber Intracardiac Thrombosis During Liver Transplantation: A Case Series

“…Precise, localized delivery of a thrombolytic agent reduces the risk for hemorrhagic complications in liver transplant recipients with significant coagulopathy, due to lower dosage used, and improved outcomes have been reported [17]. Successful use of recombinant tissue plasminogen activator (tPA) for intraoperative treatment of massive intracardiac and pulmonary thromboembolism have also been reported over the years in a few publications [18][19][20].…”

Acute heart failure after liver transplantation: A narrative review

“…CAD, coronary artery disease; CV, cardiovascular; IOC, iron overload cardiomyopathy; MRI, magnetic resonance imaging; PAC, pulmonary artery catheter; TEE, transesophageal echocardiography failure during or after liver transplantation has been reported in retrospective studies and case reports. 90,[94][95][96][97][98] It was first reported in pediatric LT patients as a viable rescue option for those experiencing profound cardiogenic shock after reperfusion. 99 Since then, there have been several case reports in the adult literature detailing the success of VA-ECMO in LT patients with myocardial ischemia, pulmonary embolism, intracardiac thrombus, biventricular failure, amongst others.…”

“…The emerging role of veno‐arterial extracorporeal membrane oxygenation (VA‐ECMO) in patients who develop refractory heart failure during or after liver transplantation has been reported in retrospective studies and case reports 90,94‐98 . It was first reported in pediatric LT patients as a viable rescue option for those experiencing profound cardiogenic shock after reperfusion 99 .…”