Cardiac Arrest with Multi-vessel Coronary Artery Disease and Successful Treatment After Long Conventional Cardiopulmonary Resuscitation: How Long Is Too Long?

Abstract

Coronary artery disease (CAD) is the most common killer disease, responsible for about one-third of all deaths at ages above 35. The majority of all survivors of out-of-hospital cardiac arrests present to the emergency department (ED) with an initial shockable rhythm (ventricular fibrillation or pulse-less ventricular tachycardia), which is a predictor of survival. Odds for survival are less for non-shockable rhythm and favorable neurologic outcomes decrease as the length of cardiopulmonary resuscitation (CPR) increases. The median time-to-return of spontaneous circulation among those with favorable neurological outcomes is less than 10 minutes. On the other hand, a large review of more than 64,000 patients with in-hospital cardiac arrests showed that patients with longer median resuscitation times had a greater chance of the return of spontaneous circulation and survival to discharge. We described a case of prolonged resuscitation lasting almost three hours of CPR followed by successful percutaneous intervention with a favorable neurologic outcome.

Computed-Tomography as First-line Diagnostic Procedure in Patients With Out-of-Hospital Cardiac Arrest

“…Out-of-hospital cardiac arrest (OHCA) remains a striking challenge for emergency and intensive care medicine, and constitutes one of the main causes of in-hospital mortality worldwide (1). More than 50% of OHCA cases are caused by coronary ischemia (1)(2)(3)(4). In Europe, mortality rates after OHCA are highly variable between countries (5,6).…”