Favourable outcome after 26 minutes of "Compression only" resuscitation: a case report

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Abstract

Case presentation

A 49 year old man had ventricular fibrillation in his home, at room temperature, due to an ST-elevation myocardial infarction. He received Cardiac compression only resuscitation (CC-only) for 26 minutes by his wife, followed by four minutes of standard CPR by other lay persons until EMS-arrival. Gasping and moaning were observed during most of the CC-only period. The ambulance arrived at 30 minutes. The first ECG showed a fine ventricular fibrillation. Restoration of spontaneous circulation (ROSC) was achieved at 49 minutes after a total of four defibrillatory shocks. The patient recovered without any cerebral damage, and was discharged to his home after eight days hospitalization.

Conclusions

This case demonstrates that early and powerful cardiac compressions alone without rescue breaths may maintain sufficient circulation and gas exchange to prevent neurological damage for more than 25 minutes. This should be kept in mind for Emergency Medical Dispatch Centrals giving Pre-arrival instructions to bystanders.

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Most cited references 7

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Cardiopulmonary resuscitation by bystanders with chest compression only (SOS-KANTO): an observational study.

(2007)

Mouth-to-mouth ventilation is a barrier to bystanders doing cardiopulmonary resuscitation (CPR), but few clinical studies have investigated the efficacy of bystander resuscitation by chest compressions without mouth-to-mouth ventilation (cardiac-only resuscitation). We did a prospective, multicentre, observational study of patients who had out-of-hospital cardiac arrest. On arrival at the scene, paramedics assessed the technique of bystander resuscitation. The primary endpoint was favourable neurological outcome 30 days after cardiac arrest. 4068 adult patients who had out-of-hospital cardiac arrest witnessed by bystanders were included; 439 (11%) received cardiac-only resuscitation from bystanders, 712 (18%) conventional CPR, and 2917 (72%) received no bystander CPR. Any resuscitation attempt was associated with a higher proportion having favourable neurological outcomes than no resuscitation (5.0%vs 2.2%, p<0.0001). Cardiac-only resuscitation resulted in a higher proportion of patients with favourable neurological outcomes than conventional CPR in patients with apnoea (6.2%vs 3.1%; p=0.0195), with shockable rhythm (19.4%vs 11.2%, p=0.041), and with resuscitation that started within 4 min of arrest (10.1%vs 5.1%, p=0.0221). However, there was no evidence for any benefit from the addition of mouth-to-mouth ventilation in any subgroup. The adjusted odds ratio for a favourable neurological outcome after cardiac-only resuscitation was 2.2 (95% CI 1.2-4.2) in patients who received any resuscitation from bystanders. Cardiac-only resuscitation by bystanders is the preferable approach to resuscitation for adult patients with witnessed out-of-hospital cardiac arrest, especially those with apnoea, shockable rhythm, or short periods of untreated arrest.

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European Resuscitation Council guidelines for resuscitation 2005. Section 2. Adult basic life support and use of automated external defibrillators.

Leo Bossaert, Margaret Handley, Koen Monsieurs … (2005)

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Cardiopulmonary resuscitation by chest compression alone or with mouth-to-mouth ventilation.

Beth L. Cobb, A Hallström, Dave E. Johnson … (2000)

Despite extensive training of citizens of Seattle in cardiopulmonary resuscitation (CPR), bystanders do not perform CPR in almost half of witnessed cardiac arrests. Instructions in chest compression plus mouth-to-mouth ventilation given by dispatchers over the telephone can require 2.4 minutes. In experimental studies, chest compression alone is associated with survival rates similar to those with chest compression plus mouth-to-mouth ventilation. We conducted a randomized study to compare CPR by chest compression alone with CPR by chest compression plus mouth-to-mouth ventilation. The setting of the trial was an urban, fire-department-based, emergency-medical-care system with central dispatching. In a randomized manner, telephone dispatchers gave bystanders at the scene of apparent cardiac arrest instructions in either chest compression alone or chest compression plus mouth-to-mouth ventilation. The primary end point was survival to hospital discharge. Data were analyzed for 241 patients randomly assigned to receive chest compression alone and 279 assigned to chest compression plus mouth-to-mouth ventilation. Complete instructions were delivered in 62 percent of episodes for the group receiving chest compression plus mouth-to-mouth ventilation and 81 percent of episodes for the group receiving chest compression alone (P=0.005). Instructions for compression required 1.4 minutes less to complete than instructions for compression plus mouth-to-mouth ventilation. Survival to hospital discharge was better among patients assigned to chest compression alone than among those assigned to chest compression plus mouth-to-mouth ventilation (14.6 percent vs. 10.4 percent), but the difference was not statistically significant (P=0.18). The outcome after CPR with chest compression alone is similar to that after chest compression with mouth-to-mouth ventilation, and chest compression alone may be the preferred approach for bystanders inexperienced in CPR.

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Author and article information

Journal

Journal ID (nlm-ta): Scand J Trauma Resusc Emerg Med

Title: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

Publisher: BioMed Central

ISSN (Electronic): 1757-7241

Publication date Collection: 2010

Publication date (Electronic): 16 April 2010

Volume: 18

Page: 19

Affiliations

[1 ]Prehospital Clinic, Vestfold Hospital Trust and Telemark Hospital Trust, Box 2168, NO-3103 Tønsberg, Norway

Article

Publisher ID: 1757-7241-18-19

DOI: 10.1186/1757-7241-18-19

PMC ID: 2873364

PubMed ID: 20398354

SO-VID: d07dac44-9ce5-40d4-9420-931dd143e2ff

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Favourable outcome after 26 minutes of "Compression only" resuscitation: a case report

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Abstract

Case presentation

Conclusions

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Preventive and Emergency Medicine Insights

Most cited references 7

Cardiopulmonary resuscitation by bystanders with chest compression only (SOS-KANTO): an observational study.

European Resuscitation Council guidelines for resuscitation 2005. Section 2. Adult basic life support and use of automated external defibrillators.

Cardiopulmonary resuscitation by chest compression alone or with mouth-to-mouth ventilation.

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