A case study in therapeutic hypothermia treatment post-cardiac arrest in a 56-year-old male.
ABSTRACT Cellular damage related to reperfusion injury after successful resuscitation may lead to increased morbidity and mortality in survivors of cardiac arrest. Therapeutic hypothermia to decrease the effects of reperfusion injury has demonstrated improved neurologic outcomes for patients who have experienced out-of-hospital cardiac arrest due to ventricular fibrillation.
A 56-year-old male remained unresponsive after successful resuscitation following an out-of-hospital cardiac arrest. A repeat cardiac arrest with pulseless electrical activity occurred in the cardiac catheterization lab and required six additional minutes of resuscitation prior to restoration of cardiac rhythm and perfusion. The patient remained unresponsive after resuscitative events. Therapeutic hypothermia was initiated and maintained for 24 hours. The patient was then rewarmed, weaned off sedation and paralytics and good neurologic function demonstrated. The patient was extubated on Day 3, transferred to the telemetry unit, and was discharged home four days after admission, neurologically intact.
Twenty-four hours of therapeutic hypothermia for patients who remain unresponsive following successful resuscitation after experiencing out-of-hospital ventricular fibrillation is a viable option for preservation of neurological function. The National Registry of Cardiopulmonary Resuscitation (NRCPR), sponsored by the American Heart Association (AHA), was developed with a goal to enhance patient safety and reduce patient disability and death through "providing an evidence-based, quality improvement program of patient safety, medical emergency team response, effective resuscitation and post-emergency care" to patients that have experienced cardiopulmonary events. NRCPR reports from 2007 include data from 127 participating organizations with information submitted on 19,555 in-patients who experienced 22,919 cardiopulmonary arrest (CPA) events. Of all of the arrests that occurred, 78.3 percent of patients involved did not survive the event. For those who did survive the event, an additional 35.2 percent died afterward, either via removal of life-support or natural death in the presence of do-not-resuscitate (DNR) directives. The remaining survivors (21.3 percent) were discharged to a variety of environments with home being the most common (48.5 percent), followed by skilled nursing facilities (19.2 percent), rehabilitation centers (12.4 percent), other acute care hospitals (11.8 percent) and hospice care (4.7 percent). From this information, it is apparent that continued research and improvements are essential to provide patients successful resuscitation and to decrease the complications that occur afterward. We present the case of a patient who remained comatose after return of spontaneous circulation (ROSC) following out-of-hospital ventricular fibrillation (VF) cardiac arrest in whom therapeutic hypothermia treatment was utilized with a positive neurological outcome.