• Naofumi Bunya, Kenshiro Wada, Ayumu Yamaoka, Ryuichiro Kakizaki, Yoichi Katayama, Takehiko Kasai, Ryoko Kyan, Naoto Murakami, Nobuaki Kokubu, Shuji Uemura, and Eichi Narimatsu.
• Department of Emergency Medicine Sapporo Medical University Sapporo Japan.
• Acute Med Surg. 2019 Apr 1; 6 (2): 197-200.

BackgroundAgonal respiration following out-of-hospital cardiac arrest is associated with favorable neurological outcomes. Resuscitation using extracorporeal membrane oxygenation could contribute to achieving favorable neurological outcomes in patients with refractory cardiac arrest.Case PresentationWe report two cases of refractory cardiac arrest with non-shockable rhythms and agonal respiration; both patients were successfully resuscitated through extracorporeal cardiopulmonary resuscitation (ECPR). Both patients were breathing spontaneously upon arrival. One patient was asystolic and the other experienced pulseless electrical activity followed by ventricular fibrillation. Agonal respiration was observed in both and ECPR was implemented, leading to a favorable neurological outcome at discharge.ConclusionThe presence of agonal respiration has the potential to confer a favorable neurological outcome in patients with refractory cardiac arrest if maintained, even when the initial cardiac rhythm is not shockable. In these cases, resuscitation should not be abandoned, and ECPR should be considered.

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