[Complete neurologic recovery after prolonged cardiac arrest caused by refractory ventricular fibrillation. Clinical case].
The clinical case of a 45-year-old patient referred to us for chest pain and with clinical examination and ECG negative for ischaemic damage, is reported. The patient, hospitalised in a bed without an ECG monitor, presented heart failure due to ventricular fibrillation. He was re-examined first with ventilation and EMC and then with defibrillation. Reanimation continued for about 70 minutes. Administration of high doses of adrenalin (0.2 mg/kg) and 9 defibrillations failed to resolve the refractory VF; nor did i.v. lidocaine administration resolve the situation. Echocardiogram did not reveal cardiac tamponade. Administration of 4 g of magnesium sulphate followed by adrenalin and defibrillation, led to asystole with subsequent restoration of sinus rhythm. The patient was then transferred to Intensive Care where he was sedated and curarized for 48 hours. The clinical course was characterised from the start by positive aspects that excluded the need to carry out instrumental investigations such as evoked somatosensory potentials, in the formulation of a prognosis. The patient was transferred to the Hospital Cardiology Unit 72 hours after admission. Two weeks later the patient was discharged with a complete recovery of neurological functions and with no metabolic or thoracopulmonary changes. It can be concluded from this experience that prognosis during CPR may not be reliable. So the factors that should lead us to carry out prolonged reanimation are the age of the patient, his pre-existing clinical conditions, the speed of our actions and correct performance of reanimation.
Giannoni
S
S
U. O. Anestesia e Rianimazione, Azienda USL 11 Empoli, Firenze.
Pappagallo
S
S
Taiti
A
A
Pasquinelli
C
C
Niccolini
S
S
D004554:Electric Countershock; D004837:Epinephrine / Q000627:therapeutic use; D006323:Heart Arrest / Q000209:etiology* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D012151:Resuscitation; D013997:Time Factors; D014693:Ventricular Fibrillation / Q000150:complications* / Q000628:therapy
D004837:Epinephrine
Completo recupero neurologico dopo arresto cardiaco prolungato da fibrillazione ventricolare refrattaria. Caso clinico.