Man Without Pulse for 96 Minutes Survives after CPR
with Help of Capnography
Mayo Clinic researcher says this may be longest
duration of pulselessness cardiac arrest that ended with a good outcome
Man being
connected for capnography. Photo be Oridion
May 2, 2011 - By all counts, the 54-year-old man
who collapsed on a recent winter night in rural Minnesota would likely
have died. He'd suffered a heart attack, and even though he was given
continuous CPR and a series of shocks with a defibrillator, the man was
without a pulse for 96 minutes.
"The patient made a complete recovery following
prolonged pulselessness," says anesthesiologist and cardiac care
specialist
Roger White, M.D., lead author of the article.
Emergency respondents administered a total of 12
defibrillator shocks and kept the patient's blood flowing with
continuous chest compressions. But a key piece of technology on the
scene was capnography, which has been used to monitor patients in
operating rooms, but is not frequently used by emergency personnel when
treating cardiac arrest.
Low health literacy
patients were older, of lower socioeconomic status and less likely to
have a high school education; also more likely to have multiple chronic
diseases - watch video
The capnography measures how much blood is flowing
through the lungs, and thereby, to other organs. As the measurement
remained sufficiently high, the rescuers were encouraged to continue
resuscitation efforts.
"A pulse gradually returned," Dr. White says. "The
effort was successful in large part because of capnography, which
informed emergency workers that if they persisted, it was conceivable
they'd have a survivor on their hands."
Once his pulse had resumed, the patient was flown
to Saint Marys Hospital in Rochester, Minn., and found to have an
occluded artery. A clot was removed and a stent inserted after the
artery was opened. He was discharged a week and a half later showing no
neurological problems from the extended period without a pulse.
Shortly after, he underwent an elective bypass
operation to treat his underlying heart disease.
"To our knowledge," Dr. White says, "this episode
is the longest duration of pulselessness in an out-of-hospital cardiac
arrest that ended with a good outcome.
The case suggests further study of advanced life
support techniques is warranted, as well as the use of real-time
technology like capnography that can validate the efficacy of
resuscitation efforts."
About Capnography in Emergency Care
On October 18, 2010, the International Liaison
Committee on Resuscitation (ILCOR) and the American Heart Association
(AHA) with the European Resuscitation Council (ERC) put forth new
guidelines to assist in cardiopulmonary resuscitation (CPR), according
to a report on the website for
Oridion, a manufacturer of capnography equipment.
Oridion specializes in capnography, the
non-invasive monitoring of a patients ventilatory status, which is
achieved by the continuous measurement and analysis of the carbon
dioxide (CO2) in a patients exhaled breath.
These guidelines, reports Oridion, are based on a
transparent, expert review of scientific evidence, informed by the
clinical expertise of the writing teams and designed to provide rescuers
and clinicians with a strategy for action that can save lives from
cardiac arrest.
The Value of Waveform Capnography
The 2010 Guidelines are powerful, says the Oridion
site, in regards to waveform capnography. Included in both the AHA and
ERC guidelines is specific language regarding capnography:
"Continuous quantitative waveform capnography is
now recommended for intubated patients throughout the periarrest period.
When quantitative waveform capnography is used for adults, applications
now include recommendations for confirming tracheal tube placement and
for monitoring CPR quality and detecting ROSC based on end-tidal carbon
dioxide (PETCO2) values."
A peer-reviewed journal, Mayo Clinic Proceedings
publishes original articles and reviews dealing with clinical and
laboratory medicine, clinical research, basic science research and
clinical epidemiology. It is published monthly by Mayo Foundation for
Medical Education and Research as part of its commitment to the medical
education of physicians. The journal has been published for more than 80
years and has a circulation of 130,000 nationally and internationally.
Articles are available online at
www.mayoclinicproceedings.com.
About Mayo Clinic
Mayo Clinic, headquartered in Rochester, Minn., is
a nonprofit worldwide leader in medical care, research and education for
people from all walks of life. For more information, visit
www.mayoclinic.org/
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