A fatal combination of situs inversus, pregnancy and cardiac arrest treated with an automated external defibrillator.

Simon Calle ,Marc De Leeuw ,Nicolas Mpotos ,Paul Calle ,Bruno De Turck

doi:10.1007/s12471-016-0852-4

Abstract

A 34-year-old female suddenly collapsed and remained comatose. She was 6 months pregnant. Information on previous medical problems could not be obtained, due to a language barrier. Upon arrival of the first tier ambulance she was unresponsive with a pulse of 30 beats/min. A few minutes later, no pulse could be detected and basic life support was started with an automated external defibrillator (AED). Self-adhesive pads were placed in the conventional sternalapical position. The first and second rhythm analyses led to a no-shock decision (Fig. 1). The third and fourth analyses gave rise to shocks (Fig. 2). The patient was transferred to the hospital with ongoing advanced cardiac life support and taken to the delivery room for caesarean section. Maternal

Highlights

This case illustrates that the specificity of shock/noshock decisions by the AEDs is not 100 % [1, 2]
A third lesson concerns the low amplitude of QRS complexes detected by the AED electrodes placed in the conventional sternal-apical position [3]. It seems reasonable in known dextrocardia cases to change to bi-axillary electrodes placement or a mirror-like approach (i. e. placement to the left of the sternum and in the right midaxillary line)
The reduced QRS amplitude in this dextrocardia case argues against the use of the abovementioned mirror-like approach in a standard cardiac arrest patient with a medical device implanted below the right clavicle

Summary

Introduction

This case illustrates that the specificity of shock/noshock decisions by the AEDs is not 100 % [1, 2]. No cause of death could be detected on autopsy.

Results

Conclusion