21st ESICM Annual Congress

• DOI: 10.1007/s00134-008-1240-3
• Publication Date: 2008-08-07T13:38:59Z
• Authors: Mafalda Miranda; Pedro Sousa; Ana Cecília Dos S...; Maria João Andrade; A Grac; Mário Santos; Rui Antunes; Cláudia Camila Dias; A Carneiro; Ernestina Gomes; Kostoula Arvaniti; Dimitrios Lathyris; Eleni Synnefaki; M. Nastou; E Blougoura; P. Papakonstantinou; Dimitrios Matamis; Jorge Paulino; José Artur Paiva; Elisabete Pereira...; Célia Ribeiro; Altamiro Costa‐Pe...; Victoria Metaxa
• Keywords: Asystole; Sinus bradycardia; Pulseless electrical activity

INTRODUCTION.Cardiac Arrest (CA) is an important cause of death, 50 percent occurring outside hospitals.One-half these patients are found in Ventricular Fibrillation (VF) or pulseless ventricular taquicardia.Within this group, better survival achieved with early defibrillation (less than four to eight minutes).Early BLS also associated survival, by delaying the deterioration cardiac rhythm asystole.METHODS.Case report. RESULTS. We describe case a 80 years old man, who suffered CA shortly after arrival his local health department, for appointment GP.Several weeks before he began suffer from typical effort angina and that day was feeling unwell.Basic Life Support (BLS) started promptly Advance (ALS) team requested through national emergency number.Nine minutes after, ALS arrived confirmed CA, VF.The victim defibrillated 200 J shock resumed.When orotracheal intubation attempted, masseter muscle contraction noticed, so discontinued reevaluation.The had become wide QRS tachycardia pulse recovered spontaneous breathing.Partial consciousness (Glasgow Coma Score: 11).On physical examination blood pressure 133/62 mmHg, heart rate 130 bpm oximetry 97%.The patient transferred department.Half hour later, as fully, complained chest pain.The ECG showed sinus 75, right bundle branch block ST segment depression leads V4 V6. Laboratorial tests troponine I 0.78 ng/ml.A coronary angiography performed urgently, disclosed significant left main plus three vessel -coronary artery disease.Left anterior descending (LAD) occluded, late retrograde flow.Eighteen hours quadruple bypass grafting operation undertaken.During surgery, fresh thrombus removed proximal LAD.Post-operative course uneventful discharged on 7 procedure.Sixteen months remains asymptomatic.CONCLUSION.This illustrates possibility happy end episode sudden undiagnosed severe disease presumable acute syndrome.Although nine witnessed collapse, return circulation first prompt breathing recovery contributed success resuscitation maneuvers.The fact occurred care facility allowed BLS, which recovery.Furthermore, speed detection treatment reversible (myocardial ischemia case) crucial long-term prognosis.