Department of Anesthesiology, Mayo Clinic, Rochester, MN 55905, USA.
Mayo Clin Proc. 2011 Jun;86(6):544-8. doi: 10.4065/mcp.2011.0229. Epub 2011 Apr 20.
A 54-year-old man with no known cardiac disease collapsed outdoors in a small rural community. The cardiac arrest was witnessed, and immediate cardiopulmonary resuscitation was begun by a bystander and a trained first responder who was nearby. The patient was moved into a building across the street for continued resuscitation. First responders arrived with an automated external defibrillator, and ventricular fibrillation was documented. First responders delivered 6 defibrillation shocks, 4 of which transiently restored an organized electrocardiographic rhythm but with no pulse at any time. Additional emergency medical services personnel from nearby communities and an advanced life support (ALS) flight crew arrived. The flight crew initiated ALS care. The trachea was intubated, ventilation controlled, and end-tidal carbon dioxide tension continuously monitored. Antiarrhythmic and inotropic drugs were administered intravenously. An additional 6 shocks were delivered using the ALS defibrillator. End-tidal carbon dioxide measurements confirmed good pulmonary blood flow with chest compressions, and resuscitation was continued until a stable cardiac rhythm was restored after 96 minutes of pulselessness. The patient was transported by helicopter to the hospital. He was in cardiogenic shock but maintained a spontaneous circulation. Coronary angiography confirmed a left anterior descending coronary artery thrombotic occlusion that was treated successfully. After hospital admission, the patient required circulatory and ventilatory support and hemodialysis for acute renal failure. He experienced a complete neurologic recovery to his pre-cardiac arrest state. To our knowledge, this is the longest duration of pulselessness in an out-of-hospital arrest with a good outcome. Good pulmonary blood flow was documented throughout by end-tidal carbon dioxide measurements.
一名 54 岁男子在一个小型农村社区户外晕倒，心脏骤停。一名旁观者和一名附近受过培训的急救人员立即对其进行心肺复苏。患者被转移到街对面的一栋建筑物中继续进行复苏。急救人员带着自动体外除颤器赶到，记录到心室颤动。急救人员进行了 6 次除颤电击，其中 4 次短暂恢复了有组织的心电图节律，但始终没有脉搏。附近社区的其他紧急医疗服务人员和一名高级生命支持（ALS）飞行机组人员也赶到了。飞行机组人员开始进行 ALS 护理。对患者进行气管插管、控制通气，并持续监测呼气末二氧化碳张力。静脉给予抗心律失常和正性肌力药物。使用 ALS 除颤器再进行 6 次电击。呼气末二氧化碳测量值证实了心肺复苏期间胸部按压时有良好的肺血流，复苏一直持续到 96 分钟无脉后恢复稳定的心脏节律。患者通过直升机被送往医院。他患有心源性休克，但维持自主循环。冠状动脉造影证实左前降支冠状动脉血栓性闭塞，治疗成功。住院后，患者需要循环和呼吸支持以及血液透析治疗急性肾衰竭。他完全恢复了心脏骤停前的神经状态。据我们所知，这是院外心脏骤停中无脉时间最长但结局良好的病例。呼气末二氧化碳测量值始终记录到良好的肺血流。
