Post-partum spontaneous coronary artery dissection and the use of veno-arterial extra-corporeal membrane oxygenation.

AIMS: To present a rare case of a post-partum spontaneous coronary artery dissection (SCAD), a rarely seen condition which does not yet have a universally agreed treatment method and the role of the intensive care unit (ICU) nurse when caring for the adult ECMO patient.

BACKGROUND: The use of extra-corporeal membrane oxygenation (ECMO) for the adult patient has increased slowly since the first reported successful treatment in 1972 (Hill et al., 1972) and is seen increasingly as a successful therapy when conventional medical treatment has failed. In this case, a young lady 2 weeks post-partum presented with acute coronary syndrome secondary to a SCAD. ECMO was used successfully as a bridge to myocardial recovery following coronary artery bypass grafts and cardiogenic shock.

DESIGN AND METHOD: A case study underpinned by a review of existing literature relating to spontaneous coronary artery dissection and extra-corporeal membrane oxygenation.

RESULTS AND CONCLUSIONS: ECMO is still a relatively new and invasive technology but continues to improve survival rates in critically ill patients where conventional medical treatment has failed. This article highlights requirement for further research into several aspects of care for the adult ECMO patient. Questions to be answered raised in this case study include recommendations for the weaning of inotropes and vasoconstrictors, frequency of blood gas sampling and whether it remains essential to have two nurses caring for the ECMO patient.

RELEVANCE TO CLINICAL PRACTICE: As medical treatment progresses, there is an increasing demand for therapies such as ECMO to become more readily available for the care of the critically ill adult patient. This article highlights challenges that may be faced and what changes could be made to further improve standards of care and survival rates for ECMO patients.