|
Temporal sequence of resuscitation events |
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| Time |
Patient status/Event |
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| 0715 – 0800 Pre-Hospital |
Patient was unresponsive with absent pedal pulses but palpable radial pulses with delayed capillary refill. A 20 ga. IV line was established and patient was intubated. Vitals were bradycardia with HR 33/minute, BP of 86/51 mm Hg, and tympanic temperature of 25.5°C. Warm IV fluids were given and hot packs were applied to groins and axillae. |
| 0800 Arrival to Hospital |
Patient arrived to medical center with no palpable pulses. Monitor showed PEA with bradycardia of HR 31/minute. CPR was started. Atropine 0.5 mg IV was administered followed by 1 mg epinephrine IV. Tympanic temperature was 25.5°C. |
| 0808 |
Patient converted to sinus rhythm with HR 66/minute, but shortly thereafter went into pulseless V-tach. An amiodarone bolus of 300 mg was administered IV followed by 1 gm calcium IV. The patient went into V-fib and CPR resumed. |
| 0812 |
Central line placed along with an additional 16 ga. IV line. Warm IV fluids were administered. |
| 0815 – 0825 |
A gastric tube and bilateral chest tubes were placed. Warm gastric and pleural irrigation was initiated. |
| 0845 |
Patient remained in V-fib arrest receiving CPR. Temperature remained 25.6°C despite conventional warming therapies of warm fluid instillation (IV, gastric, intrapleural), warm humidified oxygen, and warming blankets. The decision was made for extracorporeal rewarming and resuscitation. |
| 0845 – 0900 |
Patient was heparinized, CPS unit was assembled and primed, and arterial and venous cannulas were placed for fem-fem CPS. |
| 0900 |
Patient was placed on fem-fem CPS and CPR was stopped. Patient remained in V-fib arrest. CPS unit temperature monitoring confirmed patient blood temperature of 25.5°C. |
| 0900 – 1100 |
Patient was slowly rewarmed on CPS and electrolytes and acid base status were normalized. Patient remained in V-fib arrest. An arterial line was placed which showed a systolic BP of 55 mm Hg. Vasopressin was started. |
| 1102 |
Patient temperature was 34.9°C and defibrillation was attempted. Initial defibrillation at 200 J converted rhythm from V-fib to V-tach, and a subsequent defibrillation of 300 J converted rhythm to SVT. A bolus of 300 mg amiodarone IV was administered followed by 1 gm calcium chloride IV. |
| 1112 |
Patient reverted into V-tach. Two defibrillation attempts of 360 J converted rhythm into sinus tachycardia and HR 102/minute. Patient temperature was 35.5°C. |
| 1200 |
Patient temperature was 37°C after 180 minutes of extracorporeal rewarming. |
| 1230 |
Patient was transported to OR for weaning of CPS and decannulation under direct vision. Patient was in sinus rhythm, HR 87/minute. |
| 1330 |
Patient was successfully weaned from CPS after 270 minutes of bypass with BP 140/60, HR 80/minute, in sinus rhythm, and temperature of 37°C. |
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IV: intravenous; HR: Heart Rate; BP: Blood Pressure; J: joules; PEA: Pulseless Electrical Activity; CPR: Cardiopulmonary Resuscitation; V-Tach: Ventricular Tachycardia; V-Fib: Ventricular fibrillation; A-V: Arterio-Venous; CPS: Cardiopulmonary Support; Fem: femoral; SVT: Supraventricular Tachycardia | |
Cooper et al. Journal of Medical Case Reports 2008 2:150 doi:10.1186/1752-1947-2-150 |
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