Case report: 81 y/o female survives, neurologically intact, after prolonged resuscitation

81 y/o female with no significant past medical history presents to Dr. Bearemy's ED with chest pain.  En route to the hospital by EMS, patient was noted to have two runs of VT which responded to cardioversion.  Upon initial ED evaluation patient's vitals were stable and an EKG noted ST elevations in the inferior leads.  Cath lab was immediately notified and the usual pre-cath cardioprotective drugs were administered.  Minutes later, the patient began to have recurrent runs of V fib with loss of pulse.  ACLS measures were initiated.  After 30 minutes, intubation, 30 shocks, 10 mg of epi, 3 mg of  atropine, magnesium, amio bolus and drip, bicarb and a wide open dopamine drip, the patient regained a sinus rhythm with thready pulse and was taken to the cath lab where despite continued hemodynamic instability an occluded RCA was stented.  Patient remained in the CVU for several days where balloon pump, vasopressor and ventilatory support were gradually weened.  5 days post stent, the patient is neurologically intact with little evidence of hypoxic ischemic brain injury and retains a good cardiac ejection fraction despite some inferior wall akinesis.

After the initial resuscitation, I had prepared the patient's family for the worse but am glad to see that the patient made a fool of me.  It's cases like this that make the tough days palatable.

While I am quite impressed with the outcome of this case, there's a real case report in the American Journal of Emergency Medicine of a good neurologic outcome after 60 minutes of CPR.