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Health & Medicine for Senior Citizens

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

Connecting to capnography, photo by Oridion

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.

But this particular instance of cardiac arrest, reported first in Mayo Clinic Proceedings online, turned out to be highly unusual:

"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.

 

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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 Mary’s 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 patient’s ventilatory status, which is achieved by the continuous measurement and analysis of the carbon dioxide (CO2) in a patient’s 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."

Click here for the full list of CPR guidelines.

Notes

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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