title: Hemodynamics of cough cardiopulmonary resuscitation in a patient with sustained torsades de pointes/ventricular flutter.
abstract: A 43-year-old female with old myocardial infarction and stenosed bypass grafts developed sustained Torsades de Pointes/ventricular flutter (rate = 300-400 beats per minute) during coronary arteriography after contrast injection to the diagonal graft. Cough-CPR (rate = 37/min) was started within 5 s of dysrhythmia initiation and continued through two defibrillation attempts (200 and 360 joules), and IV lidocaine was administered until return of spontaneous circulation 62 s later. The patient never lost consciousness during this very rapid dysrhythmia. Certain cardiac arrest resuscitation measures (namely, initial defibrillation attemps, IV lidocaine administration) can thus be initiated in a patient while performing cough-CPR and maintaining adequate cerebral perfusion. During the dysrhythmia with Cough-CPR: (a) aortic systolic pressures averaged 100 mmHg--this has commonly been observed in other reports, and (b) aortic diastolic pressures were always > or = 50 mmHg and averaged 63 mmHg, which has seldom been this high during cough-CPR. Dysrhythmia reversion occurred 4 s after the second defibrillation attempt and 80 msec after the peak of the highest cough-generated aortic pressure pulse (128 mmHg). Cough-induced ventricular tachycardia reversion has previously been reported; this may have acted in concert with electrical defibrillation to facilitate dysrhythmia reversion. The patient recovered without incident.
authors.affiliation: Aurora Denver Cardiology Associates, Colorado.
authors.forename: B
authors.initials: B
authors.lastname: Miller
authors.forename: A
authors.initials: A
authors.lastname: Cohen
authors.forename: A
authors.initials: A
authors.lastname: Serio
authors.forename: D
authors.initials: D
authors.lastname: Bettock
mesh_terms: D000328:Adult; D001011:Aorta / Q000503:physiopathology; D001794:Blood Pressure; D016887:Cardiopulmonary Resuscitation / Q000379:methods; D017023:Coronary Angiography / Q000009:adverse effects; D003371:Cough; D004554:Electric Countershock; D004562:Electrocardiography; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage; D016171:Torsades de Pointes / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*
chemical_list: D008012:Lidocaine