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Five Hours of Resuscitation With 150 Electrical Shocks and Complete Recovery.
Cureus. 2021 Apr 02; 13(4):e14255.C

Abstract

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.

Authors+Show Affiliations

Cardiology, Carmel Medical Center, Haifa, ISR.Cardiology, Carmel Medical Center, Haifa, ISR.Cardiology, Carmel Medical Center, Haifa, ISR.Cardiology, Carmel Medical Center, Haifa, ISR.

Pub Type(s)

Case Reports

Language

eng

PubMed ID

33954068

Citation

Tabachnikov, Vsevolod, et al. "Five Hours of Resuscitation With 150 Electrical Shocks and Complete Recovery." Cureus, vol. 13, no. 4, 2021, pp. e14255.
Tabachnikov V, Zissman K, Sliman H, et al. Five Hours of Resuscitation With 150 Electrical Shocks and Complete Recovery. Cureus. 2021;13(4):e14255.
Tabachnikov, V., Zissman, K., Sliman, H., & Flugelman, M. Y. (2021). Five Hours of Resuscitation With 150 Electrical Shocks and Complete Recovery. Cureus, 13(4), e14255. https://doi.org/10.7759/cureus.14255
Tabachnikov V, et al. Five Hours of Resuscitation With 150 Electrical Shocks and Complete Recovery. Cureus. 2021 Apr 2;13(4):e14255. PubMed PMID: 33954068.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Five Hours of Resuscitation With 150 Electrical Shocks and Complete Recovery. AU - Tabachnikov,Vsevolod, AU - Zissman,Keren, AU - Sliman,Hussein,4th AU - Flugelman,Moshe Y, Y1 - 2021/04/02/ PY - 2021/5/6/entrez PY - 2021/5/7/pubmed PY - 2021/5/7/medline KW - acute coronary syndromes KW - cardiac arrest KW - resuscitation SP - e14255 EP - e14255 JF - Cureus JO - Cureus VL - 13 IS - 4 N2 - 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. SN - 2168-8184 UR - https://www.unboundmedicine.com/medline/citation/33954068/Five_Hours_of_Resuscitation_With_150_Electrical_Shocks_and_Complete_Recovery. DB - PRIME DP - Unbound Medicine ER -
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