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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.