He Fei, Xu Peng, Wei Zhong-Hai, Zhang Jun, Wang Jun
From the Department of Emergency Medicine (FH, PX, JZ, JW); Department of Cardiology (Z-HW), Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China.
Medicine (Baltimore). 2015 Jul;94(27):e1107. doi: 10.1097/MD.0000000000001107.
Out-of-hospital cardiac arrest (OHCA) is a crucial public health problem. To improve outcomes of patients after cardiac arrest, the American Heart Association promotes the concept of the chain of survival.We report a case of a 19-year-old man with no markedly past medical history who suffered from OHCA, and he was resuscitated with cardiopulmonary resuscitation, without interruption, during the rescue process for 120 minutes until return of spontaneous circulation (ROSC). Electrocardiogram on admission showed right bundle branch block and ST segment elevation in leads V1-V2, and the patient's uncle had experienced the same event and had received implantable cardioverter defibrillator (ICD) treatment. Therefore, the patient was diagnosed with Brugada syndrome. Postcardiac arrest care was performed after ROSC, including mild therapeutic hypothermia, hemodynamic monitoring and management, and ICD implantation, and then the patient completely recovered without any noticeable neurological or intellectual deficits in the follow-up examinations.Our case demonstrates that even after an OHCA with prolonged time (120 minutes) until ROSC, survival with a favorable neurological outcome is possible, provided implementation of an extremely effective rescue chain.
院外心脏骤停（OHCA）是一个关键的公共卫生问题。为改善心脏骤停患者的预后，美国心脏协会倡导生存链的概念。我们报告一例19岁男性病例，该患者既往无明显病史，发生了院外心脏骤停，在长达120分钟的抢救过程中持续进行心肺复苏，直至恢复自主循环（ROSC）。入院时心电图显示右束支传导阻滞及V1 - V2导联ST段抬高，且患者的叔叔曾经历过相同事件并接受了植入式心律转复除颤器（ICD）治疗。因此，该患者被诊断为Brugada综合征。恢复自主循环后进行了心脏骤停后护理，包括轻度治疗性低温、血流动力学监测与管理以及植入ICD，随后患者完全康复，在后续检查中未出现任何明显的神经或智力缺陷。我们的病例表明，即使院外心脏骤停至恢复自主循环的时间较长（120分钟），只要实施极其有效的抢救链，患者仍有可能存活且神经系统预后良好。
