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Cardiac Arrest with Multi-vessel Coronary Artery Disease and Successful Treatment After Long Conventional
Rashid Nadeem1, Hesham Osman2, Yehia Karaly3
1Intensive Care Medicine, Dubai Hospital, Dubai, ARE.
Insights
This case study highlights a rare instance of prolonged cardiopulmonary resuscitation (CPR) lasting nearly three hours, leading to successful percutaneous intervention and a favorable neurologic outcome in a cardiac arrest patient. It suggests extended resuscitation may improve survival chances in specific in-hospital cardiac arrest scenarios.
Area of Science:
- Cardiology
- Emergency Medicine
- Critical Care
Background:
- Coronary artery disease (CAD) is a leading cause of mortality.
- Out-of-hospital cardiac arrest survivors often present with shockable rhythms, predicting survival.
- Survival and neurologic outcomes diminish with longer cardiopulmonary resuscitation (CPR) times for non-shockable rhythms.
Observation:
- A case of prolonged resuscitation, nearly three hours of CPR, was documented.
- The patient achieved return of spontaneous circulation and survival to discharge.
- Successful percutaneous intervention was performed post-resuscitation.
Findings:
- Extended CPR duration, contrary to typical outcomes, was associated with a positive result in this case.
- Favorable neurologic outcome was achieved despite the extensive resuscitation period.
- This contrasts with general trends where longer CPR correlates with poorer outcomes.
Implications:
- Prolonged CPR may be beneficial in select in-hospital cardiac arrest cases.
- Further research is warranted to define optimal CPR durations for different cardiac arrest scenarios.
- This case challenges conventional understanding of resuscitation time limits and survival predictors.
Abstract:
Coronary artery disease (CAD) is the most common killer disease, responsible for about one-third of all deaths at ages above 35. The majority of all survivors of out-of-hospital cardiac arrests present to the emergency department (ED) with an initial shockable rhythm (ventricular fibrillation or pulse-less ventricular tachycardia), which is a predictor of survival. Odds for survival are less for non-shockable rhythm and favorable neurologic outcomes decrease as the length of cardiopulmonary resuscitation (CPR) increases. The median time-to-return of spontaneous circulation among those with favorable neurological outcomes is less than 10 minutes. On the other hand, a large review of more than 64,000 patients with in-hospital cardiac arrests showed that patients with longer median resuscitation times had a greater chance of the return of spontaneous circulation and survival to discharge. We described a case of prolonged resuscitation lasting almost three hours of CPR followed by successful percutaneous intervention with a favorable neurologic outcome.
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