Use of blood samples from intraosseous access in the care of critically ill seems promising but lacks investigation: A systematic review of the literature

Purpose: Rates of survival and complete physiological recovery following in-hospital cardiac arrest are poor. We present the management of a cardiac arrest in a patient undergoing toracic endovascular aortic repair (TEVAR) for toracoabdominal aortic aneurysm. Clinical features: A 57 year old man (76kg, ASA physical status 3) underwent embolisation of subclavian vein under local anaesthesia in interventional radiology laboratory. The patient underwent TEVAR one day before this procedure. After embolisation, hypotension and bradycardia occurred. Medical emergency team was called for the patient who experienced cardiac arrest. The patient underwent CPR closed-chest cardiac massage for 5minutes initially. Emergency open sternotomy was performed and open-chest cardiacmassagewas carried on afterwords. Serious bleeding at the vascular graft anastomosis and ascending aortic dissection were observed at epiaortic USG. After control of bleeding the patient was transferred to cardiovascular surgery theatre. The patient was urgently placed on cardiopulmonary bypass machine. Ascending aortic replacement and aortic valve resuspension surgery was performed with 35min of deep hypothermic circulatuIatory arrest at 16 ◦C. Termination of CPB was achieved under pharmacological and pacemaker support. Blood and blood products were transfused during surgery. Levels of lactate, blood glucose, electrolites, hemoglobin concentration were analysed in arterial blood gas samples. The patient was kept in hypotermia for 5h (<36 ◦C) at the end of the surgery. The patient was warmed up due to increased chest tube drainage. The patient suffered from respiratory failure due to pneumonia postoperatively and intermittantmechanical ventilation supportwasperformed. Thepatient was discharged from thehospital in goodneurological status at two months after surgerywith a cerebral performance score of 2 and no other organ failure. Conclusion: Successful neurological outcomes can be achieved in cardiac arrest patients undergoing TEVAR with early warning systems, good team management, effective treatment including therapeutic hypotermia.