A Case of Survival after Cardiac Arrest and 3½ Hours of Resuscitation

Abstract

I n general, outcomes after cardiac arrest remain poor, especially in patients with risk factors such as unwitnessed arrest, unfavorable initial rhythm, older age, and prolonged resuscitation without return of spontaneous circulation (ROSC). 1-4Guidelines therefore exist for terminating resuscitative efforts in cases of cardiac arrest that are deemed futile. 5,6 Nonetheless, successful resuscitation and good recovery after prolonged arrest have been documented. [7][8][9][10] As the field of cardiopulmonary resuscitative medicine evolves, new techniques are being implemented to improve outcomes in patients who are in cardiac arrest. We present an example of how recent research findings in resuscitative medicine improved one patient's chances of survival. Case ReportIn June 2011, a 40-year-old white man with a history of hypertension, hyperlipidemia, obesity (body mass index, 34.9 kg/m 2 ), and chronic tobacco use presented with presyncopal symptoms. Severe pressure-like chest pain had started 24 hours previously and had completely resolved spontaneously 12 hours before the current presentation. An electrocardiogram (ECG) showed persistent ST-segment elevation in the anterior leads. He was hemodynamically well compensated. Initial laboratory reports showed cardiac troponin I elevation to a level above 50 ng/mL.The patient was not a candidate for primary percutaneous coronary intervention (PCI) for STEMI because of his delayed presentation, the complete resolution of his chest pain, and the development of anterior Q waves on his ECG. He was admitted to the cardiovascular care unit (CCU) and was treated conservatively with antiplatelet, anticoagulant, and antiarrhythmic therapy.The next morning, a coronary angiogram revealed an occluded proximal left anterior descending coronary artery, an occluded obtuse marginal branch, and a diffusely diseased right coronary artery. On hospital day 3, a positron emission tomographic viability scan showed only minimal viable myocardium and a large area of scar tissue; therefore, the patient was not a candidate for revascularization. He remained hemodynamically stable in the CCU and was subsequently transferred to the medicine floor.At 5:37 am on hospital day 5, the patient experienced sustained ventricular tachycardia and then lost consciousness. He had no spontaneous respirations, and neither the carotid nor femoral pulses could be palpated. His airway was secured, and positive-pressure ventilation was initiated. Simultaneously, cardiopulmonary resuscita-

Extracorporeal membrane oxygenation (ECMO) for critically ill adults in the emergency department: history, current applications, and future directions

“…Reports from OHCA studies are not as robust, although there are dramatic reports of otherwise hopeless cases rescued by ECMO [ 39 ]. Haneya et al [ 40 ] compared ECPR initiated in the ED for OHCA with ECPR initiated for in-hospital cardiac arrest, and found a survival rate of 42 % for in-hospital arrest patients versus only 15 % for OHCA patients.…”

Prolonged Successful Cardiopulmonary Resuscitation with Thrombolysis in a Patient with Acute Coronary Syndrome

“…D.M. Nusbaum с коллегами в своей публикации пишут, что известны только 4 описания случаев успешной СЛР длительностью более одного часа без повреждения функций центральной нервной системы [9]. В этой же статье авторы описали свой случай успешной СЛР 40-летнего мужчины с ишемической кардиомиопатией, которая длилась примерно 3,5 ч с использованием ВАБК, ЭКМО, искусственного сердца и ортотопической трансплантации донорского сердца на 160 день после СЛР с последующей выпиской из стационара на 179 день.…”

Case of a cardiac arrest patient who survived after extracorporeal cardiopulmonary resuscitation and 1.5 hours of resuscitation

“…There are some previous reports of patients surviving with good neurologic outcomes after prolonged resuscitation for cardiac arrest. [ 3 – 5 ] The first patient was a 40-year man with a history of hypertension and hyperlipidemia who collapsed and was found to be in VF. Several rounds of CPR were performed during hospitalization, with the entire cardiac arrest lasting approximately 3.5 hours.…”

“…He was discharged from the hospital on day 179, at which time he was ambulatory. [ 3 ] The second patient was a 56-year-old man with no history of cardiac illness who collapsed and was found to be in VF. He was resuscitated by means of CPR for 60 minutes.…”