4 hours of CPR and survived (hypothermic)

visit http://drdougbrown.ca/ to see his research.

Also, I have a written synopsis of "a call" that somebody wrote on a private facebook group but I do t know if it should be posted here. I think ill just add some cliffs from it (parts that have already been presente in the media but just a little more clarification). I apologize if this isn't confidential, I believe I'm good though...

Pt fell down tree well at 0200 and found later by friends, CPR initiated. SAR arrived and pt in v fib after 120 mins of CPR. Pt had to be chipped out of ice that she had melted in to. Core temp around 18 degrees. Helicopter out, 180 mins of CPR now still v fib, defib never worked, remained in vfib until hospital (SAR members were 2 of our ALS medics) and decided to call and discuss case. Dr brown had ecmo ready. 4 hours of CPR once ecmo hooked up (very quickly). Pt ejection fraction begins to rise and neurologically things are looking good (news stated she is off ecmo and was nodding to doctors.

Hope I didn't breach confidentiality here, I haven't said anything not in te news except the rhythm was vfib.
 
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I see ECMO/ECLS becoming much more common in the future. It still requires a massive amount of support and commitment from hospitals but it undoubtedly saves lives.
 
What little I've seen of ECLS seems to support it's use but if it's used, the decision to use it (and at each step) has to be done early and implemented quickly. I think at one point I saw a link to this on EmCrit. So far, for this case, it looks like there's a reasonably decent outcome.
 
That's a pretty cool case. I'm confused though, did you mean to say CPR was continued for 4 hours after ECMO/ECLS was initiated? I thought the point of ECMO was to oxygenate and circulate blood without CPR?
 
Robb said:
That's a pretty cool case. I'm confused though, did you mean to say CPR was continued for 4 hours after ECMO/ECLS was initiated? I thought the point of ECMO was to oxygenate and circulate blood without CPR?
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I think it's opposite. CPR for four hours on hypothermic pt, then ECMO was initiated.
 
9D4 said:
I think it's opposite. CPR for four hours on hypothermic pt, then ECMO was initiated.
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This :)

I wonder if helos will be recommended for hypothermic codes. I now most won't take an arrest but if you throw on a Lucas thumper machine and cruise back to the hospital with ecmo that seems reasonable.
 
Wow, that's an incredible outcome for such a long down time! And amazing job on her friends' part.

What are peoples' protocols for treating a hypothermic code? The region where I work says only one shock and just CPR, no dugs, until the patient is warmed.
 
TheLocalMedic said:
Wow, that's an incredible outcome for such a long down time! And amazing job on her friends' part.

What are peoples' protocols for treating a hypothermic code? The region where I work says only one shock and just CPR, no dugs, until the patient is warmed.
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That's exactly what my protocol says. For severe hypothermia, <86* core temp.
 
Yup interesting stuff.

I've heard a few people talking lately about the idea that duration of cardiac arrest is less and less a predictor of outcome as long as CPR starts early. Especially with aggressive therapies like ECMO, there are some amazing outcomes. I think we're going to see the minimal time for cardiac arrests be extended out to 45 mins, maybe an hour in retrievable circumstances.


Over all, we're doing well. 2012/2013 numbers for the whole of Vic including remote and rural areas were, 37% bystander CPR, 46% get an attempt at resus from a first responder of some kind, undoubtedly many of those are stopped once actual clinicians show up (as opposed to FD, volunteers FRs etc), VF/VT: 50% ROSC, 30% discharge from hospital with <1% of arrests going to nursing care. But we could do better...

The CHEER trial currently running here in Melbourne combines intra-arrest cooling, transport with mechanical CPR, early ECMO in the ED and intra-arrest cath lab. All of this for young, healthy refractory cardiac arrest. Its a pilot trial but the early numbers are exciting. From memory, they're seeing around a 50% (about ten pts now I think) neurologically intact survival rate. Now its important to note that this isn't 50% of all comers, this is 50% of refractory arrests. These are arrests that probably weren't far from ending where the pts dropped. The investigators have talked a bit about how impressive the results are and, bugger me, I'm sold. One glass of cool aid please. I'm in.

Accidental hypothermia:>32C (89.6F) normal arrest, 30-32C, double dosage intervals for drugs, <30C (86F), one shock only, one round of drugs, no sodium bic.
 
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I seem to recall from an earlier thread here there were some caveats and issues. But then, anything presented as being "harmless" has just changed from "known-risk procedure" to "boobytrap".
 
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