Cardiac arrest in the perioperative period is associated with significant morbidity and mortality. Novel resuscitation devices may afford patients improved survival and limit neurologic injury. We report a case of cardiac arrest in the postanesthesia care unit that required an extensive period of cardiopulmonary resuscitation assisted by the ResQPOD impedance threshold device to optimize coronary perfusion and a LUCAS chest compression system to maintain optimal cardiopulmonary resuscitation while transporting the patient to the cardiac catheterization laboratory. Furthermore, after stabilization for an occluded left anterior descending artery with stent placement, an institutional hypothermia protocol was initiated using Thermogard XP Temperature Management system for 24 hours.
Bibliographical noteFunding Information:
Immediately upon arrival to the PACU, a 12-lead electrocardiogram revealed ST changes noted in the limb leads ( Fig. 1 ). Nine minutes after arrival to the PACU, the patient entered into polymorphic ventricular tachycardia ( Fig. 2 ) while talking to the cardiology team. Advanced Cardiac Life Support (ACLS) protocol was initiated and the patient underwent continuous chest compressions and mask ventilation with an Impedance Threshold Device (ITD), the ResQPod Circulatory Enhancer (Advanced Circulatory Systems, Inc, Roseville, MN), used during assisted ventilation. After the second of 2 initial cardioversions, the patient had return of spontaneous circulation (ROSC). He was responsive and breathing spontaneously, and had 9 minutes of sinus rhythm; however, his cardiac rhythm suddenly deteriorated into ventricular fibrillation. The airway was then secured with tracheal intubation again using the ResQPod device now attached to the endotracheal tube. During this second resuscitation, the patient received epinephrine, lidocaine, phenylephrine, and magnesium sulfate along with 8 cardioversions and continuous chest compressions. The LUCAS (Physio-Control Inc/Jolife AB, Lund, Sweden) device was used to ensure adequate chest compressions during the transport to the cardiac catherization laboratory, 36 minutes after the initial arrest. A 100% thrombotic occlusion of the left anterior descending coronary artery was noted ( Fig. 3 ). Successful percutaneous coronary intervention (PCI) was performed ( Fig. 4 ) with thrombectomy and stent placement 59 minutes after the initial cardiac arrest. The patient was supported by the LUCAS device for 28 minutes during the transport and initial PCI. Shortly after the PCI, the LUCAS device was removed, and an intra-aortic balloon pump was placed. The patient was transferred to the intensive care unit and sedated, and our institutional hypothermia protocol with an intravascular cooling device (Thermogard XP Temperature Management system, Zoll, Chelmsford, MA) was initiated and maintained for 24 hours per institutional protocol.
- Cardiac arrest: mechanical piston devices
- Cardiopulmonary resuscitation
- Impedance threshold device