Clinical Reasoning: Persistent respiratory failure following cardiac arrest

A 49-year-old woman was found unresponsive in bed, with ventricular fibrillation ultimately diagnosed. She was intubated and cardiac life support administered. Amiodarone was loaded and maintenance initiated. Left heart catheterization/ventriculography demonstrated no coronary artery disease, with reduced ejection fraction (EF)/global hypokinesis and dilated left ventricle. Intermittent ventricular tachycardia continued, causing recurrent arrests and metabolic acidosis. She was transitioned to extracorporeal membrane oxygenation (ECMO) with improved arrhythmias and acidosis but continued cardiogenic shock. She was transferred to an outside hospital for potential left ventricular assist device (LVAD) or cardiac transplant. © 2018 American Academy of Neurology.