I’m excited to share with you a fascinating research paper that I came across. It’s about a young patient who experienced a cardiac arrest due to a non-shockable rhythm and was successfully resuscitated after 90 minutes of continuous CPR. The best part? The patient was discharged with complete neurological recovery!

paramedic performing cpr
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According to the study, it is challenging to decide how long to continue resuscitation or when to terminate it in cases of out-of-hospital cardiac arrest (OHCA) with ongoing CPR on arrival at the emergency department. However, patients with longer code durations have a higher likelihood of ROSC and survival to discharge, particularly when the arrest is due to asystole or pulseless electrical activity (PEA).

The patient in this case was a 24-year-old man with a known history of hypertension, not on any medication, who had difficulty in breathing for a week before experiencing an OHCA. When the patient arrived at the emergency department, he was already in his 25th minute of CPR, on bag and mask ventilation, and with no IV-line inserted. The ECG showed pulseless electrical activity, and arterial blood gas showed severe acidosis with pH 6.7, PaCO2 91 mmHg, HCO3 14 mEq/L, and potassium 7 mmol/L, suggestive of hyperkalemia.

The patient received a bolus of calcium gluconate and sodium bicarbonate, and many cycles of resuscitation continued to the patient in the emergency department. After 65 minutes of continuous CPR, the first ROSC was achieved with a blood pressure of 139/90, SpO2 93%, and a heart rate of 140 bpm. However, the patient collapsed again thrice, achieving ROSC for a few seconds and arresting again. The cycles repeated until finally, after 90 minutes of continuous CPR, the patient was maintaining his vitals.

In such cases of non-shockable rhythms, the powerful defibrillator machine is not used during resuscitation. In such cases, identifying the offending cause, performing high-quality CPR, and administering epinephrine are the only effective tools in resuscitating a patient.

Post-ROSC management was initiated, and the patient was shifted to the intensive care unit (ICU) in a hemodynamically stable state for further management. The patient was discharged with complete neurological recovery after an in-hospital stay of around 2 months.

The study demonstrates how the integration of a multidisciplinary team with a high-quality resuscitation protocol in a timely manner can help achieve a positive post-resuscitation outcome. The quality of the chain-of-survival intervention and the clinical characteristics of the patient determine survival and the neurological outcome of the patient, regardless of the length of resuscitation, which can be prolonged, especially in situations of non-shockable rhythms.

Although past studies have shown that longer resuscitation durations carry the risk of cerebral hypoperfusion and are associated with lower survival rates and poor neurological outcomes, recent studies have shown that patients with longer resuscitation durations in the hospital have higher rates of achieving ROSC with positive outcomes upon discharge.

In conclusion, this study offers hope to patients with non-shockable rhythms who experience an OHCA. It highlights the importance of timely intervention and high-quality resuscitation protocols in achieving a positive post-resuscitation outcome.

We would love to hear your thoughts on this fascinating research paper! Do you have any personal experience or insights into the topic of out-of-hospital cardiac arrest and resuscitation? Please leave a comment below and share your views with us.

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[0] Abboud, Y. , Kalan, L. and Varanasi, S. (2023) Complete Neurological Recovery after Prolonged Resuscitation in a Young Patient with Non-Shockable Rhythm. Open Journal of Emergency Medicine, 11, 16-20. doi: 10.4236/ojem.2023.111002.
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[2] Torke, A.M., Bledsoe, P., Wocial, L.D., Bosslet, G.T. and Helft, P.R. (2015) Cease: A Guide for Clinicians on How to Stop Resuscitation Efforts. Annals of the American Thoracic Society, 12, 440-445.
[3] Tabachnikov, V., Zissman, K., Sliman, H. and Flugelman, M.Y. (2021) Five Hours of Resuscitation with 150 Electrical Shocks and Complete Recovery. Cureus, 13, e14255.
[4] He, F., Xu, P., Wei, Z.-H., Zhang, J. and Wang, J. (2015) Complete Recovery with the Chain of Survival after a Prolonged (120 Minutes) Out-of-Hospital Cardiac Arrest Due to Brugada Syndrome. Medicine, 94, e1107.
[5] Youness, H., Al Halabi, T., Hussein, H., Awab, A., Jones, K. and Keddissi, J. (2016) Review and Outcome of Prolonged Cardiopulmonary Resuscitation. Critical Care Research and Practice, 2016, Article ID: 7384649.
[6] Andersen, L.W., Bivens, M.J., Giberson, T., et al. (2015) The Relationship between Age and Outcome in Out-of-Hospital Cardiac Arrest Patients. Resuscitation, 94, 49-54.

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