(1548) Treating NOMI After Hypothermia for OHCA With Continuous Papaverine Infusion: A Case Report

Introduction: Non-occlusive mesenteric ischemia (NOMI) is caused by risk factors such as heart failure, hypovolemia, and the use of vasopressor drugs, and it has a high mortality rate. No consensus exists on the treatment of NOMI. The timing of surgery or endovascular therapy remains difficult, and the efficacy of continuous papaverine administration has not been established.

Description: A 75-year-old male was transported to the ED for out-of-hospital cardiopulmonary arrest (OHCA) due to cardiac amyloidosis. After the return of spontaneous circulation, targeted temperature management (TTM) therapy was started in the ICU with a target body temperature of 34℃ to treat post-cardiac arrest syndrome. On the sixth day after completing temperature restoration, the patient vomited, prompting a CT scan that suggested NOMI due to portal vein emphysema and mural emphysema. Angiography showed stenosis (2.8 mm) of the main trunk of the superior mesenteric artery (SMA), confirming a diagnosis of NOMI; therefore, continuous arterial infusion therapy with papaverine was started. Twenty-four hours after treatment, angiography showed an improvement in SMA diameter (5.3 mm) and peristalsis, and enteral feeding was resumed. The patient was transferred to the hospital for rehabilitation on the 24th day after achieving full enteral nutrition.

Discussion: In this case, the patient was diagnosed with NOMI after TTM for postcardiac arrest syndrome, and continuous papaverine infusion was effective. Although patients after OHCA are considered at high risk of developing NOMI, few reports of angiography exist, likely due to the unstable general condition of these patients. According to a previous cardiovascular surgery report, the diameter of SMA vessels decreased by 30% and blood flow decreased by 50% at 28–32℃, suggesting that blood flow was also decreased during temperature management therapy at 34℃. We conclude that NOMI should be aggressively suspected in cases of vomiting during hypothermia therapy and that continuous papaverine infusion may increase survival and discharge.