Successful cardiopulmonary cerebral resuscitation in patient with severe acute pancreatitis

摘要

Severe acute pancreatitis (SAP) is a critical illness in clinical practice, which is characterized by intensive inflammatory response in the early phase and infected pancreatic necrosis in the later phase. Despite the knowledge of SAP and critical care support technology got significant progress in recent years, SAP still carries approximately 30% mortality rate. Some SAP patients also havemany other kinds of underlying disease such as hyperlipidemia, hypertension, coronary atherosclerotic heart disease, and heart rhythm abnormalities, which are related to cardiopulmonary arrest to some extent. Thus, the incidence of unpredictive cardiopulmonary arrest is high. Recently, a SAP patient in our intensive care unit had sudden cardiac arrest. After 52 minutes of cardiopulmonary resuscitation, she had return of spontaneous circulation and regained consciousness within 2 hours. To our knowledge, there is no successful report after such long resuscitation in SAP patients. She was receiving continuous renal replacement therapy (CRRT) and continuous veno-venous hemofiltration, in the event of cardiopulmonary arrest. No study reported what kind of role CRRT can play when cardiac arrest occurs. Usually, we would stop existing CRRT when cardiac arrest occurred. We would not start CRRT for the complexity of operation and additional loss of blood. This time, we used CRRT to regulate electrolyte and acid-base imbalance and implement hypothermia brain protection, which played an important role in the patient that we report here. We strongly recommended a prolonged cardiopulmonary cerebral resuscitation in some not quite old SAP patients and continue to use existing CRRT but not remove it.