Pediatric Cardiac Arrest From Tumor-Associated Pulmonary Embolism: Diagnostic Insights From Imaging After Extracorporeal Cardiopulmonary Resuscitation.

backgroundTumor-associated pulmonary embolism is a rare but potentially fatal cause of cardiac arrest. CASE SUMMARY: An 8-year-old girl experienced sudden cardiac arrest and required extracorporeal cardiopulmonary resuscitation (ECPR). Point-of-care ultrasound demonstrated right ventricular dilation with impaired contractility, prompting emergent contrast-enhanced computed tomography (CT). An abdominal tumor and bilateral pulmonary artery occlusion were identified on CT, suggesting tumor-associated pulmonary embolism. Extracorporeal membrane oxygenation support was established; however, the patient developed irreversible hypoxic-ischemic brain injury. A limited biopsy confirmed the diagnosis of Ewing sarcoma. DISCUSSION: Post-ECPR imaging was crucial in identifying the underlying etiology. This case highlights the importance of comprehensive imaging in cardiac arrest and the ethical challenges of ECPR when cardiac pathology is reversible but the neurological prognosis is poor. TAKE-HOME MESSAGES: Point-of-care ultrasound and CT after ECPR can identify rare reversible causes of cardiac arrest. Tumor-associated pulmonary embolism should be considered in unexplained cases. ECPR decisions require balancing neurological prognosis with the treatability of the underlying pathology.