Neurologic Recovery Following Prolonged Out-of-Hospital Cardiac Arrest With Resuscitation Guided by Continuous Capnography

June 2011
Mayo Clinic Proceedings;Jun2011, Vol. 86 Issue 6, p544
Academic Journal
A 54-year-old man with no known cardiac disease collapsed out- doors in a small rural community. The cardiac arrest was witnessed, and immediate cardiopulmonary resuscitation was be- gun by a bystander and a trained first responder who was nearby. The patient was moved into a building across the street for continued resuscitation. First responders arrived with an automated external defibrillator, and ventricular fibrillation was documented. First responders delivered 6 deflibrillation shocks, 4 of which transiently restored an organized electrocardiographic rhythm but with no pulse at any time. Additional emergency medical services personnel from nearby communities and an advanced life support (ALSO) flight crew arrived. The flight crew initiated ALS care. The trachea was intubated, ventilation controlled, and end-tidal carbon dioxide tension continuously monitored. Antlarrhythmic and inotropic drugs were administered intravenously. An additional 6 shocks were delivered using the ALS defibrallator. End-tidal carbon dioxide measurements confirmed good pulmonary blood flow with chest compressions, and resuscitation was continued until a stable cardiac rhythm was restored after 96 minutes of pulselessness. The patient was transported by helicopter to the hospital. He was in cardiogenic shock but maintained a spontaneous circulation. Coronary angiography confirmed a left anterior descending coronary artery thrombotic occlusion that was treated successfully. After hospital admission, the patient required circulatory and ventilator support and hemodlalysis for acute renal failure. He experienced a complete neurologic recovery to his pro-cardiac arrest state. To our knowledge, this Is the longest duration of pulseiessness in an out- of-hospital arrest with a good outcome. Good pulmonary blood flow was documented throughout by end-tidal carbon dioxide measurements.


Related Articles

  • Cardiac arrest can be less of a gamble. Lincoln, Tim // Nature;11/16/2000, Vol. 408 Issue 6810, p302 

    Discusses the use of defibrillating equipment in casinos and airplanes in order to treat victims of cardiac arrest more efficiently. Success rates of American Airline's system as compared to the national average; Evidence which suggests that the age of the defibrillator user need not be a...

  • The Northern Ireland Public Access Defibrillation (NIPAD) study: effectiveness in urban and rural populations. Moore, M. J.; Hamilton, A. J.; Cairns, K. J.; Marshall, A.; Glover, B. M.; McCann, C. J.; Jordan, J.; Kee, F.; Adgey, A. A. J. // Heart;Dec2008, Vol. 94 Issue 12, p1614 

    Objective: To assess the impact of mobile automated external defibrillators (AEDs) on out-of-hospital cardiac arrests (OHCAs) in urban and rural populations. Design: Prospective before and after intervention, population study. Setting: Urban and rural areas of 160 000 each. Patients,...

  • AEDs SAVE LIVES. EMERY, MICHAEL SCOTT // American Fitness;Mar/Apr2015, Vol. 33 Issue 2, p54 

    The article examines the use of automated external defibrillators (AEDs) as a device for aiding individuals in the moments following sudden cardiac arrest. Topics discussed include the events that lead to a heart attack and the inevitability of death in the absence of treatment. The application...

  • Studies examine location, temperature of therapeutic hypothermia for cardiac arrest. Ellis, Brian; Foster, Melissa; Kalvaitis, Katie; Swain, Erik // Cardiology Today;Jan2014, Vol. 17 Issue 1, p18 

    The article reports on the study that investigates whether prehospital cooling improved outcomes after resuscitation from cardiac arrest in patients with and without ventricular fibrillation (VF), and found 62.7% of survival rate for the intervention group and 64.3% for the control group.

  • Statistical Versus Individual Forecasting Of Life-Threatening Cardiac Arrhythmias. Wessel, Niels; Meyerfeldt, Udo; Ziehmann, Christine; Schirdewan, Alexander; Kurths, Ju¨rgen // AIP Conference Proceedings;2002, Vol. 622 Issue 1, p110 

    Ventricular tachycardia or fibrillation (VT) as fatal cardiac arrhythmias are the main factors triggering sudden cardiac death. The objective of this investigation is to find early signs of sustained VT in patients with an implanted cardioverter-defibrillator (ICD). These devices are able to...

  • An escalating higher-energy regimen was better than a fixed lower-energy regimen for defibrillation in out-of-hospital cardiac arrest.  // ACP Journal Club;Sept/Oct2007, Vol. 147 Issue 2, p33 

    The article presents a study to determine whether an escalating higher energy regimen was better than fixed lower-energy regimen for arrhythmia termination with an automated external defibrillator (AED) using a biphasic waveform in patients with out-of-hospital cardiac arrest. The study...

  • Maximizing Survival from Out-of-Hospital Cardiac Arrest: Putting Effective Emergency Cardiac Care Into Practice. Bobrow, Bentley J.; Aufderheide, Tom P.; Brady, William J. // Emergency Medicine Reports;5/12/2008, Vol. 29 Issue 11, p121 

    The article discusses the practice of effective cardiac care for patients who suffered out-of-hospital cardiac arrest. In the U.S., 350,000 to 450,000 deaths are caused by cardiopulmonary arrest per year. Included are details of the physiology of resuscitation from ventricular fibrillation...

  • New study finds in-hospital delays for defibrillation.  // Cardiovascular Devices & Drugs;Jan2008, Vol. 14 Issue 1, p12 

    The article discusses the results of a study conducted by a team from Mid-America Heart Institute of St. Luke's Hospital and the University of Michigan Cardiovascular Center. Using an analysis of data from the National Registry of Cardiopulmonary Resuscitation, the researchers found that 30% of...

  • Cardiac Arrest.  // JAMA: Journal of the American Medical Association;1/4/2006, Vol. 295 Issue 1, p124 

    A review of the causes, diagnosis, treatment and prevention of cardiac arrest is presented. The author reviews how cardiac arrest results in a cease of blood flow, which causes organs to shut down. If it is treated within a few minutes, serious damage can be prevented. The use of defibrillation,...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics