Resuscitation 105 (2016) e21–e22
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Letter to the Editor The longest persisting ventricular fibrillation with an excellent outcome – 6 h 45 min cardiac arrest Sir, In February 2015 a group of speleologists was buried by an avalanche in Tatra Mountains, Poland. The accident happened at 2:38 p.m. and 4 victims were reported to Tatra Mountain Rescue Service – two recovered and two under the snow. Due to severe weather conditions (wind blasts of up to 120 km/h and heavy snow fall) the rescue helicopter could not be used and the first mountain rescuers were on site after 2 h. A 25-year-old woman was covered by 40 cm of snow in vertical position with some air-space around the head which enabled her to breath. She was extricated by her companions after 2 h of burial, GCS 11 (4/4, 2/5, 5/6) with clear airways. Soon after that (at 5:30 p.m.) the victim experienced ventricular fibrillation cardiac arrest. Three unsuccessful shocks were delivered and manual CPR was started and continued during evacuation. The endotracheal tube (reinforced, 8 mm) was successfully inserted. The patient was transported with manual external chest compression and bag ventilation with 100% oxygen. The automatic external chest compression device failed, possibly due to weather conditions. The terrain was very difficult, so at 8:35 p.m. the patient was finally delivered to ambulance, where the automatic chest compression
device (LUCAS® ) could be used. The core temperature (in esophagus) was below 17 ◦ C. At 9:30 p.m. the patient was handed over to helicopter medical service (HEMS), and CPR was continued throughout the flight to Cracow (distance of 128 km). All of the rescue procedures including management during evacuation and transfer had been coordinated by Severe Hypothermia Treatment Center (SHTC) in Cracow, Poland. At 11:15 p.m. ECMO Veno-arterial was implemented in SHTC. The initial core temperature was 16.9 ◦ C, persisting VF. After rewarming to 24.8 ◦ C the patient was successfully defibrillated. The patient required ECMO support for a total of 91 h until cardiovascular stability was achieved. During first hours of treatment an overt pulmonary and peripheral oedema occurred, being a result of massive crystalloid and blood products transfusions, needed to maintain intravascular volume. On the 1st and 2nd day of ICU stay a laparotomy and relaparotomy were performed due to massive fluid transudation causing abdominal compartment syndrome. Due to acute renal failure, CRRT was temporarily necessary. The patient regained full consciousness and was extubated on day 6. The patient underwent successful rehabilitation program and returned home on day 26. The sequence of events of the rescue operation (Fig. 1) Cardiac function was also preserved with ejection fraction of 60%. In a year follow-up, the patient was found fully recovered without any physical or mental sequelae.
Fig. 1. The sequence of events of the rescue operation.
http://dx.doi.org/10.1016/j.resuscitation.2016.05.022 0300-9572/© 2016 Elsevier Ireland Ltd. All rights reserved.
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Letter to the Editor / Resuscitation 105 (2016) e21–e22
Conclusion
Aleksander Zelias Polish Medical Air Rescue, Warsaw, Poland
We present here the longest, to our knowledge persisting ventricular fibrillation (405 min) with an excellent outcome. A chain of survival is a key to success in standard cardiopulmonary resuscitation, and so does Severe Hypothermia Treatment Center protocol of management of hypothermic patients.1,2
Winicjusz Marcinkowski Severe Accidental Hypothermia Center, Department of Anesthesiology and Intensive Care, The John Paul II Hospital, Medical College of Jagiellonian University, Cracow, Poland Grzegorz Filip Department of Cardiovascular Surgery and Transplantology, Collegium Medicum, Jagiellonian University, the John Paul II Hospital, Cracow, Poland
Financial support None declared. Conflict of interest statement
Robert Galazkowski a,b Polish Medical Air Rescue, Warsaw, Poland b Department of Emergency Medical Services, Medical University of Warsaw, Poland a
None declared. References 1. Truhláˇr A, Deakin CD, Soar J, et al. European Resuscitation Council Guidelines for Resuscitation 2015: Section 4. Cardiac arrest in special circumstances. Resuscitation 2015;95:148–201. ´ 2. Darocha T, Kosinski S, Jarosz A, et al. Severe accidental hypothermia center. Eur J Emerg Med 2015;22:288–91.
Sylweriusz Kosinski a,b Tatra Mountain Rescue Service, Zakopane, Poland b Department of Anesthesiology and Intensive Care, Pulmonary Hospital, Zakopane, Poland a
Tomasz Darocha a,b,∗ Severe Accidental Hypothermia Center, Department of Anesthesiology and Intensive Care, The John Paul II Hospital, Medical College of Jagiellonian University, Cracow, Poland b Polish Medical Air Rescue, Warsaw, Poland a
Anna Jarosz Severe Accidental Hypothermia Center, Department of Anesthesiology and Intensive Care, The John Paul II Hospital, Medical College of Jagiellonian University, Cracow, Poland Lukasz Migiel Tatra Mountain Rescue Service, Zakopane, Poland
Rafal Drwila Severe Accidental Hypothermia Center, Department of Anesthesiology and Intensive Care, The John Paul II Hospital, Medical College of Jagiellonian University, Cracow, Poland ∗ Corresponding
author at: Severe Accidental Hypothermia Center, Department of Anesthesiology and Intensive Care, The John Paul II Hospital, Medical College of Jagiellonian University, Cracow, Poland. E-mail addresses:
[email protected] (S. Kosinski),
[email protected] (T. Darocha),
[email protected] (A. Jarosz),
[email protected] (L. Migiel),
[email protected] (A. Zelias),
[email protected] (W. Marcinkowski), grzegorzfi
[email protected] (G. Filip),
[email protected] (R. Galazkowski),
[email protected] (R. Drwila). 23 May 2016
