Authors: Sipahi N et al.
Cureus 17(10): e95783, October 2025. DOI: 10.7759/cureus.95783
This case report describes a 71-year-old woman with mild cognitive impairment who survived 110 minutes of cardiopulmonary resuscitation for pulmonary embolism, achieving full neurological recovery after extracorporeal CPR (ECMO). Initial field ultrasound showed severe right ventricular strain consistent with massive pulmonary embolism. Despite intubation, thrombolysis with alteplase, mechanical compressions, and intermittent ROSC, circulation could not be sustained. After a regional referral delay and helicopter transport, ECMO was initiated 110 minutes post-arrest with subsequent hemodynamic stabilization and preserved organ function.
CT confirmed bilateral pulmonary emboli, and the patient was managed supportively without thrombectomy. She regained consciousness on ECMO day two, was decannulated after successful weaning, and later underwent femoral artery reconstruction due to cannulation injury. Her postoperative course was uncomplicated, and she was discharged to rehabilitation on ICU day 11. Six months later, she remained mobile with a walker and had a Cerebral Performance Category score of 1, indicating normal neurological function.
This report highlights the life-saving potential of extracorporeal CPR even after prolonged resuscitation when a reversible cause is present and teamwork between emergency and in-hospital providers is well-coordinated. It also raises ethical and logistical concerns regarding rigid ECMO inclusion criteria that may exclude patients capable of meaningful recovery.
What You Should Know:
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Successful eCPR is possible after ultra-prolonged resuscitation in cases with reversible pathology such as pulmonary embolism.
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Restrictive ECMO criteria may inadvertently prevent access for patients with real potential for recovery.
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Prehospital ultrasound and early ECMO activation significantly improve outcomes when integrated into regional systems of care.
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Ethical, individualized decision-making should outweigh rigid age or comorbidity exclusions in ECMO candidacy.
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Effective coordination between EMS, air rescue, and ECMO centers is essential for favorable outcomes.
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