While completing departure procedures, Moretti suddenly collapsed, turned blue, and lost his heartbeat. Airport medical staff performed external chest compressions before transferring him to Tam Anh General Hospital, Ho Chi Minh City, within 20 minutes.

Upon arrival, Doctor Duong Pham Van Thanh from the Emergency Department, reported the patient was in critical condition. He presented with full-body cyanosis, rapid breathing, unpalpable carotid and femoral pulses, and an SpO2 of 45% (normal is over 95%). The medical team immediately performed external chest compressions to resuscitate him from cardiac arrest. Monitor images further revealed the patient was experiencing ventricular tachycardia with a heart rate of nearly 190 beats per minute, a dangerous arrhythmia that can lead to recurrent cardiac arrest.

Doctors quickly administered emergency defibrillation, antiarrhythmic drugs, intubation, and mechanical ventilation. Bedside paraclinical tests and imaging diagnostics were also performed. After a few minutes of intensive resuscitation, the patient's heart rate became regular and stable, blood pressure was measurable, and skin cyanosis reduced. Professor Vo Thanh Nhan, Director of the Interventional Cardiology Center, diagnosed Moretti with acute myocardial infarction complicated by severe hemodynamic instability, indicating a high risk of mortality.

Moretti had a complex medical history, including coronary artery disease complicated by heart failure. He had previously undergone bypass surgery, followed by coronary stent implantation, and a CRT-D device (a three-chamber pacemaker that supports patients with severe heart failure or high risk of ventricular fibrillation leading to sudden death) implantation 10 years prior. One month ago, he underwent a second intervention to replace the CRT-D device with the latest generation to help synchronize myocardial contraction and reduce the risk of sudden death.

Following a consultation, doctors decided on an emergency intervention for Moretti. His left anterior descending artery branch was re-stenosed, causing an occlusion. However, this vessel was small and unsuitable for a second stent implantation due to a high risk of re-stenosis, so the team opted for drug-coated balloon angioplasty. Compared to stent placement, drug-coated balloons do not require a metal scaffold within the vessel, thereby reducing the risk of re-stenosis, particularly in cases where multiple stents are already present.

The angioplasty procedure was completed within 20 minutes. Doctors inserted a drug-coated balloon, with a diameter matching the vessel's, and inflated it at the re-stenosed site. This allowed the drug on the balloon to be absorbed into the coronary artery wall, preventing re-stenosis. The balloon was then deflated and removed. After the intervention, the left anterior descending branch reopened, restoring blood flow to the heart.

Doctors perform drug-coated balloon angioplasty to treat the patient's re-stenosed coronary artery branch. Photo: Tam Anh General Hospital

Doctors perform drug-coated balloon angioplasty to treat the patient's re-stenosed coronary artery branch. Photo: Tam Anh General Hospital

After the procedure, Moretti's ejection fraction (EF) was only about 15% (normal is ≥ 50%), necessitating close monitoring during his recovery. Doctor Ngo Nhu Ngoc from the Intensive Care Unit (ICU), stated that the team continuously adjusted medications, controlled arrhythmias, and closely monitored blood gases, electrolytes, and kidney function. Simultaneously, doctors re-evaluated the function of the previously implanted CRT-D device to ensure it was working effectively at this critical time.

After many hours of resuscitation, the patient's hemodynamics gradually stabilized, and vasopressor doses were slowly reduced. Heart function improved step by step, Moretti regained consciousness, and continued treatment for heart failure and rehabilitation exercises.

The Italian cardiac arrest patient receives care in the ICU. Photo: Tam Anh General Hospital

The Italian cardiac arrest patient receives care in the ICU. Photo: Tam Anh General Hospital

Doctor Ngoc noted that this was a fortunate case of out-of-hospital cardiac arrest, saved due to early resuscitation and intervention. Even a delay of a few minutes would have led to a very high risk of irreversible brain damage or death.

Doctors recommend that elderly individuals with a history of cardiovascular disease, previous heart surgery, or implanted cardiac devices should adhere to regular follow-up appointments to detect potential risks early and prevent sudden cardiovascular events.

Nhat Thanh - Thu Ha

*Patient's name has been changed