Intact neurological status after induced therapeutic hypothermia in cardiac arrest

Abdel H Noureldin,Muhammad Mubashir Zahid,Rabia Shahzad Siddiqui

doi:10.5348/crint-2014-5-cr-3

Abstract

Introduction: Cardiac arrest patients in whom return of spontaneous circulation (ROSC) is achieved after resuscitation frequently develop irreversible neurological impairments owing to hypoxic injury and reperfusion induced cell death. Therapeutic hypothermia has become a standard strategy in specific unconscious adult patients with ROSC after out-of-hospital cardiac arrest (OHCA) as per American Heart Association (AHA) guidelines. Case Report: A 48-year-old South Asian male arrived to our emergency department with 20 minutes duration of OHCA with no basic life support (BLS) measures en route to hospital. His initial rhythm was ventricular fibrillation and he had ROSC after 13 minutes of cardiopulmonary resuscitation (CPR) and subsequently underwent therapeutic hypothermia for 24 hours and recovered completely without neurological impairment after eight days of incident. Conclusion: Therapeutic hypothermia in eligible cardiac arrest patients is an important component of the post-cardiac arrest care in the AHA chain of survival. The AHA chain of survival is a chain of five interdependent links for cardiac arrest and comprises early recognition, early CPR, early defibrillation, early advanced cardiac life support and post-cardiac arrest care. It has substantial benefits on patient outcome. The ease of administration and positive clinical outcome should encourage other medical professionals to avail this modality.

Highlights

IntroductionOut-of-hospital cardiac arrest (OHCA) is a leading cause of death worldwide. Improving Emergency medical services (EMS) services and bystander first aid measures are increasing the number of such patients presenting to the emergency departments and reaching return of spontaneous circulation (ROSC)
Cardiac arrest patients in whom return of spontaneous circulation (ROSC) is achieved after resuscitation frequently develop irreversible neurological impairments owing to hypoxic injury and reperfusion induced cell death
Improving Emergency medical services (EMS) services and bystander first aid measures are increasing the number of such patients presenting to the emergency departments and reaching return of spontaneous circulation (ROSC)

Summary

Introduction

Out-of-hospital cardiac arrest (OHCA) is a leading cause of death worldwide. Improving Emergency medical services (EMS) services and bystander first aid measures are increasing the number of such patients presenting to the emergency departments and reaching return of spontaneous circulation (ROSC). Reported here is a case of OHCA due to hypertrophic cardiomyopathy, whose initial rhythm was ventricular fibrillation and who showed complete neurological recovery eight days after induction of therapeutic hypothermia following cardiopulmonary resuscitation (CPR). The purpose of presenting this case report is to encourage and spread awareness of timely application of therapeutic hypothermia in eligible patient population. On arrival patient was in a cardiac arrest with initial rhythm of fine ventricular fibrillation. Patient had a normal computed tomography (CT) scan of the brain and cardiac catheterization. The patient was following commands with a GCS of 15 During his stay in the ICU, he had a neurology consult and no neurological pathology was found with normal electroencephalography. Figure 1: 12-lead ECG of patient at return of spontaneous circulation

DISCUSSION

CONCLUSION