A 56 year old male is cleaning out his garage with his wife when she hears him fall. She turns around to find him unresponsive on the ground. He is making gasping breath sounds but otherwise does not respond when she shakes him and yells at him. She is instructed to perform CPR by pre-arrival instructions after calling 911 on her cellphone. Within minutes, the BLS Fire Department arrives and takes over. After confirming that the patient is pulseless, they resume CPR while applying an AED. The AED states “shock advised” for ventricular fibrillation. After resuming CPR after one shock is delivered, the ALS ambulance arrives. High performance CPR is continued and the patient is defibrillated three more times for persistent ventricular fibrillation. The end-tidal CO2 is 40 mmHg. The patient has now been pulseless for almost twenty minutes. The paramedics plan on continuing high performance CPR, but wonder what they will do if the patient remains in ventricular fibrillation with a good end-tidal 10 minutes from now…
As we have improved the care of patients in out-of-hospital arrest, many agencies are now facilitating advanced therapies for patients with refractory ventricular fibrillation.
How does your EMS system manage these patients? Please share your comments below. A summary of discussion points will posted to the blog at the end of the month.