A Perfect Resuscitation Saves a Patient with Refractory Ventricular Fibrillation

This was contributed by Dr. Johanna Moore, one of my Hennepin Colleagues who researches CPR, along with Keith Lurie and Demetris Yannopoulos.  She translated her research knowledge into a spectacular resuscitation.Case A 54 year old male presented via ambulance to the Emergency Department (ED) in cardiac arrest. He was found down outside a clinic, where bystander CPR was initiated by clinic staff. The amount of down time was unclear but thought to be minimal as this was a high traffic pedestrian area. He received an estimated 5 minutes of manual CPR, then, after medic arrival, 20 minutes of LUCAS CPR, including use of the inspiratory threshold device (ITD, ResQPod) pre-hospital. He was noted to be in refractory ventricular fibrillation by paramedics. As part of his pre-hospital care, a King airway was placed, he was defibrillated 7 times, and received 300 mg IV amiodarone, followed by 150 mg IV amiodarone. He also received 2 mg epinephrine. He was noted to be “chewing” on the King airway and was also given 2 mg IV versed for this. On arrival to the ED (after 25 minutes of pre-hospital CPR), the patient had agonal respirations and had brief movements of his upper and lower extremities while on LUCAS. [The presence of gasping, or agonal, respirations during cardiac arrest is associated with improved survival1,2.]  His continuous end tidal CO2 readings throughout the case averaged in the 30s mmHg (a sign of effective CPR and good outcome).LUCAS CPR, with ITD u...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs