CPR for over 5 hours revived hypothermic cardiac arrest patient: a report

At 22:33, after arrival at a mountain pass at 2750 m, he developed ventricular fibrillation (VF), which initially responded to immediate defibrillation, but then recurred. ROSC was achieved two more times with a total of six defibrillations; his blood pressure was 120/70 mmHg. During resuscitation, he was intubated. A Swiss rescue helicopter with night-flying capability was requested to transport the patient directly to an ECLS rewarming centre. When the helicopter arrived at 23:40, his oesophagal temperature was 26.0 °C. An electrical warming blanket (Geratherm® UniqueResc+, Geratherm Medical AG, Geschwenda, Germany) was placed on his abdomen, and a mechanical chest compression device was placed in case of VF recurrence.

Soon after, VF recurred and was terminated with one defibrillation, but after a few minutes, VF recurred again. Three further defibrillation attempts remained unsuccessful; thus, continuous CPR with mechanical chest compression (AutoPulse®, Zoll Medical, Cologne, Germany) was started, further defibrillation attempts were considered obsolete at a core temperature of 26.0 °C [3]. Weather conditions again precluded transport to the ECLS centre and he was air transferred to the closest rural hospital. An arterial blood gas analysis showed a pH of 7.2, lactate 11.2 mmol/L, partial pressure of oxygen in arterial blood (paO2) 18.1 kPa, and potassium 2.7 mmol/L. This encouraged the team to continue CPR and conventional rewarming and to push for either transport of the patient to an ECLS centre or for a portable ECLS device to be transferred to the patient. In the meantime, the mechanical chest compression device was exchanged with a LUCAS®, because it featured a plug-in power supply (LUCAS®, Jolie AB, Physio-Control, Lund Sweden). Conventional rewarming was performed with forced warm air (Bair Hugger®, 3 M, St. Paul, MN, USA) over his abdomen and inferior extremities and intravenously with warmed normal saline. Warm cotton blankets were placed on his chest around the LUCAS® device and over his head and changed every 15–30 minutes. The net rewarming rate was 0.7 °C/hour.

After a total of 5 hours and 44 minutes of CPR with 4 hours of mechanical CPR and at a core temperature of 29.8 °C, conversion into sinus rhythm occurred spontaneously with sustained ROSC. Finally, at 5:30 a.m., transport by terrestrial ambulance was undertaken across a mountain pass. At 6:20 a.m., weather conditions allowed transport by air to the nearest ECLS center (Zurich, Switzerland). On arrival, his core temperature was 33.4 °C, sinus rhythm. By then, ECLS rewarming was no longer required.

On the second day after admission to the ECLS centre, he was awake with a Glasgow Coma Scale of 15. Respiratory and renal failure required mechanical ventilation and continuous hemofiltration, followed by intermittent dialysis with good recovery of renal function. He was ventilated for 12 days, extubated on day 15 and discharged from the intensive care unit on day 20. Seven weeks after the accident, he was discharged home from rehabilitation with complete neurological recovery despite a persisting neuropathy in his feet and hands. Four months after the accident, he resumed his job.