Anesthesiology Department, Hospital Curry Cabral, Lisbon, Portugal.
Scand J Trauma Resusc Emerg Med. 2009 Dec 11;17:63. doi: 10.1186/1757-7241-17-63.
An 80 years old man suffered a cardiac arrest shortly after arrival to his local health department. Basic Life Support was started promptly and nine minutes later, on evaluation by an Advanced Life Support team, the victim was defibrillated with a 200J shock. When orotracheal intubation was attempted, masseter muscle contraction was noticed: on reevaluation, the victim had pulse and spontaneous breathing.Thirty minutes later, the patient had been transferred to an emergency department. As he complained of chest pain, the ECG showed a ST segment depression in leads V4 to V6 and laboratory tests showed cardiac troponine I slightly elevated. A coronary angiography was performed urgently: significant left main plus three vessel coronary artery disease was disclosed.Eighteen hours after the cardiac arrest, a quadruple coronary artery bypass grafting operation was undertaken. During surgery, a fresh thrombus was removed from the middle left anterior descendent artery. Post-operative course was uneventful and the patient was discharged seven days after the procedure. Twenty four months later, he remains asymptomatic.In this case, the immediate call for the Advanced Life Support team, prompt basic life support and the successful defibrillation, altogether, contributed for the full recovery. Furthermore, the swiftness in the detection and treatment of the acute reversible cause (myocardial ischemia in this case) was crucial for long-term prognosis.
一位 80 岁的男性在抵达当地卫生部门后不久发生心脏骤停。立即开始进行基本生命支持，九分钟后，高级生命支持团队评估后对患者进行了 200J 除颤。在尝试进行经口气管插管时，注意到咬肌收缩：重新评估时，患者有脉搏和自主呼吸。三十分钟后，患者被转至急诊部。由于他抱怨胸痛，心电图显示 V4 到 V6 导联 ST 段压低，实验室检查显示心肌肌钙蛋白 I 略有升高。紧急进行冠状动脉造影：发现显著的左主干加三支血管冠状动脉疾病。心脏骤停后十八小时，进行了四支冠状动脉旁路移植术。在手术中，从中部左前降支中取出了新鲜血栓。术后过程顺利，患者在手术后七天出院。二十四个月后，他仍无症状。在这种情况下，立即呼叫高级生命支持团队、及时进行基本生命支持和成功除颤，共同促成了完全康复。此外，迅速发现和治疗急性可逆原因（本例为心肌缺血）对长期预后至关重要。
