Key result
A 66-year-old man achieved complete neurological recovery and survived asymptomatically at one year after undergoing five hours of resuscitation involving 150 defibrillations and coronary stenting.
Why the study?
When cardiac arrest involves shockable rhythms and a reversible cause of ischemia, deciding when to terminate prolonged resuscitation is complex.
Case Report (n=1)
No
Prolonged resuscitation of up to 5 hours with recurrent defibrillations can result in complete neurological recovery if high-quality CPR is maintained and the reversible ischemic cause is successfully treated.
Should not yet change resuscitation protocols; leaves open whether prolonged efforts benefit select reversible arrests.
BACKGROUND: Myocardial ischemia may lead to lethal arrhythmias. Treatment of these arrhythmias without addressing the cause of ischemia may be futile. The length of resuscitation is an important parameter for determining when to stop resuscitation but with shockable rhythms and reversible cause of the cardiac arrest, the decision to terminate resuscitation is complex. Case Summary: A patient with a three-month history of shortness of breath with effort developed pulseless ventricular tachycardia (VT) at the early stages of a stress test. In coronary angiography, a critical lesion in the right coronary artery (RCA) was observed and treated with two stents. During the procedure and for a total of five hours, the patient had more than 100 separate episodes of VT and ventricular fibrillation (VF) that were treated by 150 defibrillations, artificial ventilation, intra-aortic counter-pulsation balloon insertion, and multiple drugs. One hour after the initial stenting procedure, thrombosis of the RCA was demonstrated and treated successfully with angioplasty. Use of procainamide resolved the arrhythmias and the patient recovered completely without neurological deficit, ejection fraction of 45%, and is asymptomatic at one year following the event. DISCUSSION: Our case shows that with a revisable cause of cardiac arrest, resuscitation should be directed at maintaining perfusion of essential organs and treating the reversible cause. Without re-opening the RCA, we could not have saved the patient's life. The use of an extracorporeal membrane oxygenator, if available, should be considered in similar cases. Finally, the quality of cardiopulmonary resuscitation determines the neurological outcome regardless of the length of resuscitation, as was evident in our patient who recovered completely.
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Tabachnikov et al. (2021) conducted a case report in Cardiac arrest due to acute coronary syndrome with recurrent ventricular tachycardia/fibrillation (n=1). Prolonged resuscitation and percutaneous coronary intervention was evaluated on Survival and neurological recovery. A 66-year-old man achieved complete neurological recovery and survived asymptomatically at one year after undergoing five hours of resuscitation involving 150 defibrillations and coronary stenting.