Patient T.D.T (44 years old, residing in Dong Tam commune, Dong Nai province) was initially treated at the lower level with a diagnosis of acute myocardial infarction. After initial treatment according to the protocol, the family requested to transfer the patient to Military Hospital 175 for further intensive treatment.
At the time of admission at Military Hospital 175, the patient was in severe chest pain, sweating profusely, pale. The electrocardiogram recorded images of posterior hypocardia, in the 3rd hour. This is a very high-risk group of patients, prone to malignant heart rate disorders or cardiac arrest due to damage to the vascular system. According to medical history, the symptoms started about 2 hours ago, the patient had to travel a long distance from the baseline to the upper level, the chest pain was severe, irritation and effort increased the risk of cardiovascular collapse.
During the process of the doctors explaining the condition and the very serious prognosis for the family, the patient suddenly developed arrhythmia and cardiac arrest. Immediately, the Emergency Team performed advanced cardiopulmonary resuscitation: external chest compression, defibrillation, endotracheal intubation, artificial ventilation and vasopressure medication. The patient had a recurrence of heartbeat, but ventricular fibrillation and cardiac arrest continued to recur many times; each electric shock only maintained the heartbeat for a very short time.
Faced with a critical situation, the risk of imminent death and the risk of transporting patients to the Cardiovascular Intervention Room, doctors of the Emergency Department and the Intensive Care and Anti-poisoning Department unanimously decided to implement extracorporeal circulatory support (ECMO) according to the E-CPR strategy. This is a technique that temporarily replaces heart and lung function with an extracorporeal artificial circulatory system, playing a role as a "life-connecting bridge" for patients in critical stages.
During the ECMO placement process, the Emergency team continuously maintained circulation by compression of the heart, vasopressors, monitoring invasive blood pressure; the Resuscitation team proceeded to place a system of catheters and veins through the patient's thighs. After about 30 minutes, the patient was successfully connected to ECMO, circulatory and respiratory functions were ensured to be stable, creating safe conditions to transfer the patient to the Cardiovascular Intervention Room.
The coronary angiography results recorded a complete blockage of a branch of the right coronary artery. Doctors intervened to reopen the coronary artery and successfully placed a stent. After a week of treatment and monitoring, the patient recovered well and was discharged from the hospital.
According to Dr. Nguyen Canh Chung, Department of Intensive Care and Toxicology, Military Hospital 175, this case shows the particularly important role of ECMO in severe cardiovascular emergency, especially in patients with myocardial infarction complications of heart shock, malignant arrhythmia or circulatory arrest. “E-CPR technique helps maintain circulation, protect important organs and ensure safety for patients during transfer from the Emergency room to the Intervention room, contributing to a clear improvement in treatment results,” the doctor shared.
