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Survival after cardiac arrest is reported in various resources with markedly varied rates of success. Survival after prolonged CPR is even less common and more often associated with poor neurologic outcomes. There are few reports of repeated successful outcomes in patients with prolonged CPR that don't involve unique circumstances, such as accidental hypothermia, massive pulmonary embolism and severe hyperkalemia.(1,2)
However, the three cases from Allina Medical Transportation and the Allina Hospital System, in St. Paul, Minn., discussed in "Case Reports" in "The Truth about CPR" supplement to September JEMS, represent typical cardiac arrests without extenuating circumstances. We found only one article describing survival from prolonged CPR using a different mechanical CPR device.(3) Given the state of the pertinent literature, we thought our experience with cardiac arrest survival was important to describe.
Click here to read the case reports.
As opposed to other literature reports, these events weren't prompted by unusual pre-event scenarios or clearly identifiable causes.(4) They were as routine as cardiac arrests can be. Their similarities include that each patient was older than 65 at the time of their arrest, and that all had immediate CPR upon recognition of their condition. Also, once ALS providers arrived, all had CPR by a LUCAS device, rapid placement of the ResQPOD, an impedance threshold device (ITD), and early therapeutic hypothermia. Finally, each survived with normal neurologic function.
Although they had few similarities, these cases differed in many important ways. They occurred in very different places. While one occurred at the emergency department (ED) of a local hospital where the staff is well trained in the importance of good CPR and cardiac arrest care, another occurred in a rural town. In the second case, the EMS agency and the local hospital worked together to provide excellent care using new technology and practices to maintain the patient's condition until she could be transferred to a tertiary hospital for definitive intervention and care. Finally, the last case occurred in a busy, urban setting where a large ambulance service was trained to provide optimal care of the cardiac arrest victim and transfer to a leading resuscitation center for care.
In addition to location of the cardiac event, these cases differ in presenting rhythm, etiology of arrest and health of the patient prior to the event. One patient had an ejection fraction (EF) of 18% prior to the arrest, and another had no previous heart disease.
The limitations of this case report are that events like this may occur daily and are not reported. However, because these three happened within a 12-month period in our system, we reassessed our data and encouraged prolonged resuscitation efforts on all victims of cardiac arrest. And while the survival of these three patients who survived cardiac arrest after more than 30 minutes of CPR might not define a medical breakthrough, they do indicate a need for further investigation of the use of ITDs, mechanical CPR and therapeutic hypothermia as complementary therapies in the care of cardiac arrest.
Disclosure: The authors have reported no conflicts of interest with the sponsor of this supplement.
References
- Braque S, Bernard-Bertrand F, Guillou N, et al: "Successful but prolonged resuscitation after local anesthetic-induced cardiac arrest: is clonidine effective?" Acta Anaesthesiologica Belgica. 59(2):91–94, 2008.
- Cavallaro F, Sandroni C, Bocci MG, et al: "Good neurological recovery after cardiopulmonary resuscitation and thrombolysis in two old patients with pulmonary embolism." Acta Anaesthesiologica Scandinavica. 53(3):400–402, 2009.
- Risom M, Jorgensen H, Rasmussen LS, et al: "Resuscitation, prolonged cardiac arrest, and an automated chest compression device." Journal of Emergency Medicine. Feb. 12, 2009 (epub ahead of print).
- Wise R, Higginson I, Benger J, et al: "Lower limb amputation with CPR in progress: Recovery following prolonged cardiac arrest." Emergency Medicine Journal. 23(3):e20, 2006.
