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.


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