The team successfully revives, and treats, a patient in cardiac arrest who had gone beyond the window of opportunity for return of spontaneous circulation (ROSC) Chennai, Tamil Nadu, India (NewsVoir) • A sudden cardiac arrest can be fatal if not treated within 3 to 5 minutes. If blood circulation to the brain is not restored within 3 minutes it deprives oxygen to the brain, causing irreversible brain damage.
• Despite a downtime of 20 minutes in reaching the hospital, the patient survived a massive cardiac arrest without sustaining any brain damage • In India, 10 % of deaths occur due to sudden cardiac arrests A 27 year old man was brought to Kauvery Hospital Emergency department in the late evening with no signs of life; he had suffered intense chest pain at home followed by a sudden cardiac arrest. It took around 20 minutes to get him to the hospital.
The team immediately started Advanced Cardiac Life Support (ACLS) resuscitative measures; he received emergency electrical cardioversion (shocks) with no reversion to normal rhythm; his chances of survival were remote, with high likelihood of brain damage leaving him in a vegetative state, which is the global experience under such circumstances.
The efforts to revive the young man went on in full swing for over 30 mins. Briefly he got back the heartbeat, only to slip back soon into cardiac arrest. Hopes crashed as he began sinking again.
In this grim scenario, Kauvery Hospital, one of the leading healthcare chains in Tamil Nadu, successfully revived this young victim of “out of hospital cardiac arrest” which carries a very grim prognosis.
“The patient was brought to the emergency room, having already passed the window of opportunity to receive treatment that can hope to achieve any likely revival back to life. He was pulseless; his pulse, breathing, BP and oxygen level could not be recorded. While receiving vigorous and continued cardiac resuscitation, he was immediately transferred to the Hybrid Cath Lab. Emergency V-A ECMO support (Extra Corporeal Membrane Oxygenator) was initiated in no time. The ECMO instantly started supporting the functions of the lung and heart, with its pump outside the human body, which maintained the blood flow and delivery of oxygen to the vital organs – the brain, the kidney and the liver etc.,” said Dr. Manoj Sivaramakrishnan, the attending Senior Interventional Cardiologist at Kauvery Hospital Chennai.
He further added, “While the patient remained in cardiac arrest, ECMO assisted in successful high risk angioplasty and stenting with a bioresorbable coronary scaffold (dissolving stent - another novel treatment in heart disease) that re-canalized (opened) the 100% blocked artery, restoring normal flow to the heart. He was looked after by the multi-disciplinary critical care team; the ECMO support was removed after 3 days and much to everyone’s surprise and delight, this young man sprung back to normal conscious state, with no trace of brain defect or paralysis.” After 4 days he suffered another heart attack at midnight hours which was also successfully treated. His heart function recovered from initial 20% to a near- normal 55%. Later he walked back home after a medical miracle.
This gratifying outcome is very rare, and is extremely challenging to cardiologists and emergency care physicians as a delay by every second will lead to severe brain damage where the patient will remain in a state of coma for rest of his life (vegetative state) or die.
Patient was likely in a state of suspended animation which could explain his zero brain injury according to Dr. Manoj Sivaramakrishnan. He says this is an instance that highlights the fact that timely resuscitation and ECMO supported resuscitation - eCPR - are central to, and crucial in, the management of victims of cardiac arrest. None should be sent away without immediately initiating life support resuscitation when brought with a history of short period of unresponsiveness.
“Kauvery Hospital always offers 24x7 ECMO services. In this case, with immediate Advanced Cardiac Life Support, intervention with Angioplasty and Stenting and ECMO support, we succeeded in bringing him back to normal life with zero brain damage or neurological complications,' he added.
Speaking about this successful treatment, Dr. Aravindan Selvaraj, Co-founder and Executive Director, Kauvery Hospital said, 'More awareness needs to be created on responding to sudden cardiac arrests. Lot of them do not know what should be done and they end up losing their near and dear ones. It is very critical to contact an ambulance service or commute to the nearest hospital to get the required medical intervention within the stipulated time. This unique case of cardiac arrest is a high watermark to achieve in the field of medicine. Such sterling quality of treatment can be performed only with high expertise and excellent infrastructure. I congratulate Dr. Manoj and team for helping the patient regain his life with zero complications.' PWR PWR