Paraplegia after successful extracorporeal cardiopulmonary resuscitation: a case report

Background: We reported a patient who had paralysis of both lower limbs after successful ECPR, yet recovered after implementing clinical management timely. Case: A 16-year-old student who experienced a 40-min episode of unconsciousness. Upon the patient’s collapse, immediate cardiac compression and electrical defibrillation were per-formed. Emergency medical services transferred the patient to the emergency room for continuous cardiopulmonary resuscitation. Traditional cardiopulmonary resuscitation (CPR) and anti-arrhythmic drugs were ineffective in reversing ventricular fibrillation or pulseless ventricular tachycardia. Subsequently, venous-arterial extracorporeal membrane oxygenation (VA-ECMO) was successfully performed. The patient’s sinus rhythm was recovered 93 min after running the machine. Vital signs remained stable on the fifth day, and ECMO was removed. On day 7, the patient had paralysis of both lower limbs, with the disappearance of deep and shallow sensations. Complete spinal magnetic resonance imaging (MRI) revealed swelling in the conus medullaris segment, leading to a diagnosis of spinal cord ischemia and hypoxia injury. Management was performed, including anti-inflammation, nerve nutrition, microcirculation improvement, and rehabilitation training of both lower limbs. One year later, the patient had grade IV muscle strength in both lower limbs and could stand and walk for a short distance with the assistance of a walking aid. Conclusions: ECPR represents the final choice for patients with CPR refractoriness, potentially improving survival rates.

Out-of-hospital cardiac arrest; Hypertrophic cardiomyopathy; Sympathetic electrical storm; Extracorporeal cardiopulmonary resuscitation; Paralysis; Spinal cord ischemia

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