Contributed by Demetris Yannopoulos, MD
A subset of sudden cardiac arrest patients who do not respond to initial resuscitation efforts may be revived with early transport to a cardiac catheterization laboratory (CCL) and ongoing emergency life support. Early transport to the CCL, preferably within 30 minutes of event, allows for the discovery and correction of the underlying causes of SCA in patients presenting with ventricular fibrillation or tachycardia.1 The following case study illustrates the efficacy of this approach in a patient who could not be resuscitated in the field.
A 56-year-old female suffered sudden cardiac arrest while driving and crashed her car. Paramedics on the scene observed a shockable rhythm and attempted to defibrillate the patient. The patient received 300 mg of amiodarone, and paramedics attempted to defibrillate the patient again. Her heart rhythm, however, could not be stabilized with repeated defibrillation attempts.
Participants in the Minnesota Resuscitation Consortium (MRC), the paramedics followed the MRC sudden cardiac arrest protocol and immediately mobilized the resuscitation team at University of Minnesota Medical Center’s cardiac catheterization laboratory (CCL). The team consists of critical care physicians, cardiologists, and interventional cardiologists specializing in life support and primary coronary intervention.
In transport to the CCL, the patient received ongoing cardiopulmonary resuscitation with a Lund University Cardiac Arrest System (LUCAS) automated CPR device. Transfer from the scene to the CCL occurred in under 30 minutes, meeting the protocol’s recommended time to transport.
Upon arrival to the University of Minnesota Medical Center CCL, the patient was discovered to have a coronary artery dissection, which was cutting off blood flow to the left side of her heart. A total of 35 defibrillation shocks were delivered to restart the patient’s heart, all of which were unsuccessful. Life support with veno-arterial extracorporeal membrane oxygenation and therapeutic hypothermia was initiated.
Interventional cardiologists successfully revascularized the dissected artery. Postintervention, a single defibrillation shock was sufficient to restart the patient’s heart. She had received 1 hour and 25 minutes of CPR before revascularization.
Despite successful defibrillation, the patient remained comatose. Initial neurological assessment was grim and suggested that the patient had experienced severe anoxic brain injury. She was admitted to the intensive care unit and received ongoing life support via extracorporeal membrane oxygenation for 3 days and with a balloon pump for 5 days. Twelve days after arrival to the CCL, the patient regained consciousness and began moving and speaking soon after. Upon further neurological evaluation, the patient received a Cerebral Performance Category score of 1, which is the highest score.
Three months after sudden cardiac arrest, the patient went on vacation with her daughter. Today, she actively volunteers within the community of cardiac arrest survivors.
More than 50% of VF patients with cardiac arrest are refractory to defibrillations. This patient likely had strong perfusion of vital organs as a result of ongoing CPR that, along with extracorporeal life support measures, contributed to her brain-healthy survival from SCA. This patient met several of the clinical pathway’s criteria indicating immediate transport to CCL. These included at least 3 attempts to defibrillate, administration of 300 mg of amiodarone, CPR with a LUCAS automated CPR device, and transfer to the CCL in less than 30 minutes post-cardiac arrest.1
A new protocol helps improve brain-healthy survival rates for a subset of sudden cardiac arrest patients. Developed and implemented in Minnesota, the approach is now being tested nationally.Continue reading