The Real-World Boards: Question #28
After this much CPR ... now what?
These are the Real-World Boards. As in the real world, there may be no single “right” answer, and you are only competing against yourself. Upgrade to the Lifelong Learner level for full access to all the questions and unlimited CME credits with an included Learner+ account.
A man is brought by ambulance after experiencing an out-of-hospital cardiac arrest. He received bystander CPR and multiple shocks for ventricular fibrillation, achieving ROSC after less than 10 minutes. He was intubated by EMS.
ECG on arrival shows occlusive MI with ST-segment elevations. He undergoes emergency left heart catheterization and PCI with stenting of a 100% occlusion of the left anterior descending artery, achieving patency. He then experiences another VF cardiac arrest on the cath lab table. After multiple defibrillations, CPR, fluoroscopy to confirm stent patency and rule out pneumothorax, and placement of a microaxial flow pump (Impella™), he has remained in cardiac arrest for the past 20 minutes. The rhythm has been pulseless electrical activity for the past several cycles of ACLS. Transesophageal echocardiogram shows no pericardial effusion, weak left ventricle contraction, and a non-dilated right ventricle. ETCO2 is 15 mmHg with good quality CPR.
