Download Time - Journal of Medical Case Reports

Time
Patient status/event
7.15 to
Patient was unresponsive with absent pedal pulses but palpable radial
8 a.m.
pulses with delayed capillary refill. A 20 gauge intravenous line was
Prehospital
established and the patient was intubated. Vitals signs included
bradycardia with a heart rate of 33 beats per minute, blood pressure of
86/51mmHg, and tympanic temperature of 25.5°C. Warm intravenous
fluids were given and hot packs were applied to the groin and axillae.
8 a.m.
Patient arrived at the medical center with no palpable pulses. Monitoring
Arrival at
showed pulseless electrical activity with bradycardia; heart rate of
hospital
31 beats per minute. Cardiopulmonary resuscitation was started. Atropine
0.5mg intravenous was administered followed by 1mg epinephrine
intravenous. Tympanic temperature was 25.5°C.
8.08 a.m.
Patient converted to sinus rhythm with a heart rate of 66 beats per minute,
but shortly thereafter went into ventricular fibrillation. Amiodarone 300mg
intravenously followed by 1g calcium intravenously were administered.
Cardiopulmonary resuscitation resumed.
8.12 a.m.
Central line placed along with an additional 16 gauge intravenous line.
Warm intravenous fluids were administered.
8.15 to
Gastric and bilateral chest tubes were placed. Warm gastric and pleural
8.25 a.m.
irrigation was initiated.
8.45 a.m.
Patient
remained
in
ventricular
fibrillation
arrest
while
receiving
cardiopulmonary resuscitation. Temperature remained at 25.6°C despite
conventional warming therapies of warm fluid instillation (intravenous,
gastric, intrapleural), warm humidified oxygen, and warming blankets. The
decision was made for extracorporeal rewarming.
8.45 to
Patient was heparinized, a cardiopulmonary support unit was assembled
9 a.m.
and primed, and arterial and venous cannulas were placed for fem-fem
cardiopulmonary support.
9 a.m.
Patient
was
placed
cardiopulmonary
ventricular
on
fem-fem
resuscitation
fibrillation
arrest.
was
The
cardiopulmonary
stopped.
Patient
cardiopulmonary
support
remained
support
and
in
unit
temperature monitor documented an initial patient blood temperature of
25.0°C.
9 to
Patient was slowly rewarmed on cardiopulmonary support and electrolytes
11 a.m.
and acid-base status were normalized. Patient remained in ventricular
fibrillation arrest. Arterial line documented a systolic blood pressure of
55mmHg. Vasopressin was started.
11.02 a.m.
Patient temperature was 34.9°C and defibrillation was attempted. Initial
defibrillation at 200 J converted rhythm from ventricular fibrillation to
ventricular tachycardia, and a subsequent defibrillation of 300 J converted
rhythm to supraventricular tachycardia. A bolus of 300mg amiodarone
intravenous was followed by 1g calcium chloride intravenous.
11.12 a.m.
Patient reverted to ventricular tachycardia. Two defibrillation attempts of
360 J converted rhythm into sinus tachycardia and heart rate was 102
beats per minute. Patient temperature was 35.5°C.
12 noon
Patient temperature was 37°C after 180 minutes of extracorporeal
rewarming.
12.30 p.m.
Patient was transported to the operating room for weaning off
cardiopulmonary support and decannulation under direct vision. Patient
was in sinus rhythm with a heart rate of 87 beats per minute.
13.30 p.m.
Patient was successfully weaned from cardiopulmonary support after
270 minutes of bypass with a blood pressure of 140/60mmHg, heart rate
of 80 beats per minute, in sinus rhythm, and a temperature of 37°C.