title: Full recovery case after 82 minutes out-of-hospital cardiac arrest: importance of chain of survival and predicting outcome.
abstract: A middle age man underwent immediate cardiopulmonary resuscitation (CPR) for ventricular fibrillation (VF) occurred in an ambulance. After arrival in a regional hospital, return of spontaneous circulation (ROSC) was achieved 82 minutes after the collapse. He was in coma even three hours after ROSC. So, he was transferred to our university hospital to receive therapeutic hypothermia (TH). An initial bispectral index (BIS) value suggested a favorable outcome. Thus we decided to aggressive therapies including TH of 34°C for 48 hours, followed by a very slow rewarming at the rate of 1°C per day. Eventually he was discharged from the hospital with good neurological state. This case shows us two points: 1) the importance of the chain of survival: CPR done immediately after the collapse, persistent CPR for refractory VF, followed by coronary interventions after ROSC, continuing care to the university hospital, 2) decision making for TH using BIS monitoring.
authors.affiliation: 1 Department of Emergency and Critical Care Medicine, Ehime University , Graduate School of Medicine, Tohon, Ehime, Japan .
authors.forename: Hironori
authors.initials: H
authors.lastname: Matsumoto
authors.forename: Kensuke
authors.initials: K
authors.lastname: Umakoshi
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kikuchi
authors.forename: Shigeki
authors.initials: S
authors.lastname: Uemura
authors.forename: Kouji
authors.initials: K
authors.lastname: Takahashi
authors.forename: Jun
authors.initials: J
authors.lastname: Takeba
authors.forename: Masaru
authors.initials: M
authors.lastname: Ohboshi
authors.forename: Mayuki
authors.initials: M
authors.lastname: Aibiki
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000503:physiopathology / Q000628:therapy*; D020127:Recovery of Function / Q000502:physiology; D017694:Rewarming / Q000379:methods; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000503:physiopathology / Q000628:therapy*