Abstract
Chest compression is important in cardiopulmonary resuscitation. However, life support algorithms do not specify when chest compression should be initiated in patients with persistent spontaneous normal breathing in the early phase after cardiac arrest. Here we describe the case of a 69-year-old man who underwent femoral bypass surgery and was extubated at the end of the procedure. After extubation, the patient's breathing pattern and respiratory rate were normal. The patient subsequently developed ventricular fibrillation, evident on two monitors. Because defibrillation was ineffective, chest compression was initiated even though the patient had spontaneous normal breathing and defensive motor reflexes, which were continued throughout resuscitation. He regained consciousness and underwent tracheal extubation without neurological sequelae on postoperative day 1. This case highlights the necessity of chest compression in the early phase of cardiac arrest.
Highlights
The 2010 American Heart Association recommendations and European Resuscitation Council guidelines for cardiopulmonary resuscitation (CPR) focus on the requirement of immediately initiating chest compression and ventilation to maintain cerebral blood flow and adequate gas exchange, respectively [1]
We present a 69-year-old man with uninterrupted spontaneous normal breathing during CPR
A significantly increased incidence of ventricular tachycardia (VT) and ventricular fibrillation (VF) has been reported after reperfusion therapy for patients with myocardial infarction and systemic acidosis [4]
Summary
The 2010 American Heart Association recommendations and European Resuscitation Council guidelines for cardiopulmonary resuscitation (CPR) focus on the requirement of immediately initiating chest compression and ventilation to maintain cerebral blood flow and adequate gas exchange, respectively [1]. Some studies have shown that conscious, spontaneous breathing may continue for a short time after cerebral perfusion stops; for example, repeated rhythmic coughs every 1–3 s maintained consciousness for up to 39 s in three patients who developed ventricular fibrillation during coronary arteriography [2]. Cardiac arrest survivors recall memories of awareness, fear, and persecution after CPR [3]. Diagnosis of cardiac arrest may prolong spontaneous breathing and consciousness by maintaining cerebral perfusion through effective chest compression. We present a 69-year-old man with uninterrupted spontaneous normal breathing during CPR
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