HCMC_P_049062 - Hennepin County Medical Center

Case Reports
Resuscitation: Four Case Reports
“...the medical
community
did not widely
recognize and
promote
artificial
respiration
combined
with chest
compressions
as a key part of
resuscitation
following
cardiac arrest
until the middle
of the 20th
century.”
The effectiveness of cardiopulmonary
resuscitation, (CPR) is often seen in
movies and television as a highly effective
way to save the life of someone who is not
breathing. In fact, a 1996 study published
in the New England Journal of Medicine
showed that the CPR success rate in TV
shows was 75% for immediate circulation,
and 67% survival to discharge. 1 This gives
the general public an unrealistic expectation
of a successful outcome when, on average,
the actual survival rates for a patient who
gets CPR after a cardiac arrest is 5-10
percent. Where CPR is followed by
defibrillation, within three to five minutes of
VF cardiac arrest, survival rates rise to
about 30 percent. 2
The case reports in this issue are more in
line with the reality of how lives are saved
in our emergency departments. In addition,
the history and improving technology of
pre-hospital resuscitation is also detailed in
the Emergency Medical Perspectives
feature that follows the case studies.
Amazing stuff when you consider that the
medical community did not widely recognize
and promote artificial respiration combined
with chest compressions as a key part of
resuscitation following cardiac arrest until
the middle of the 20th century.
The “ABC’s of Resuscitation” was written
by Peter Safar in 1957 and CPR was first
promoted as a technique for the public to
learn in the 1970s. Ernie Ruiz, MD, a
founding member of Emergency Services
at HCMC, considers this one of the most
significant advances in resuscitation during
his tenure as a resuscitation surgeon and
emergency physician.
“These techniques were applied to all
forms of resuscitation in the 1960s. In my
opinion, we should also look to advancements
in fiber optic instrumentation that enabled
quicker and safer airway management and
advances in pre-hospital care and emergency
care coordination in urban and rural areas.
In addition, there have been advances in
medical imaging, CT, MRI and transvascular
techniques that are used to
discover and repair conditions such as
coronary occlusions and cerebral aneurysms.
Not to mention, the digital age in general.”
The cases that follow are examples.
References
1. (Diem, S.j.; Diem, Susan J MD; Lantos, John D
MD; Tulsky, James A MD (1996-06-13).
“Cardiopulmonary Resuscitation on Television-
Miracles and Misinformation”)
2. Cardiopulmonary Resuscitation Statistics
(http://www.americanheart.org)
Resuscitated Cardiac Arrest after
a Prolonged Down-time: Advances
in Care
Steve Smith, MD and Brian Mahoney, MD
Department of Emergency Medicine
Hennepin County Medical Center
Abstract
Cardiac arrest remains a major cause of
mortality in the US. However, new
advances in out-of-hospital, emergency
department, and intensive care have
provided hope for improved outcomes.
Here we describe a case of a patient who
benefited from new technologies that were
applied to all aspects of his acute care.
Case Report
An athletic male in his 40s was biking on a
trail when bystanders witnessed him go
down but, reportedly, without significant
trauma. They found him unresponsive and
without a pulse. They started chest
compressions and called 911. First
responders and paramedics were dispatched
at T = 1 minute. The subsequent events are
as follows:
T = 5 minutes: Minneapolis Fire
Department (MPD, first responders)
arrived. They continued CPR, placed a
King airway, with the ResQPod ® (Inspiratory
Threshold Device [ITD]) applied between
King and Valve-Mask. Respirations were
delivered at 10 per minute, as guided by
the flashing light on the ITD. An automatic
2 | Approaches in Critical Care | January 2013