Female patient, 65 years of age, secretariat of a medical center, with a history of essential hypertension in pharmacological treatment with Losartan.
She presented CPA witnessed in her workplace; in the same place basic cardiopulmonary recovery (CPR) maneuvers were initiated by trained non-medical operators (workers).
After approximately 5 minutes, the maneuvers were managed by anesthetists who arrived at the site, who performed them for approximately 15 minutes.
When a biphasic defibrillator was used, ventricular fibrillation (VF) was found.
Establishment plan was implemented with 200 Joules.
Resuscitation maneuvers were maintained for two minutes and sinus rhythm was reanalyzed.
Pulse was observed, which was present but weak.
CPR was continued and the patient was transferred to the emergency department.
During her transfer the patient presented 3 new episodes of VF, so she was successively deflated.
During this period, 4 mg atropine and 5 mg magnesium sulphate were administered.
Upon admission to the Emergency Department of our hospital he was in sinus rhythm with spontaneous ventilation.
The patient was intubated orotracheally and 2000 cc of 0.9% saline solution was administered at a temperature of 4oC.
In his neurological examination at admission he highlighted "Glasgow Coma Scale" (GCS) 3 points, ocular vagabond, bilateral mydriasis and bilateral extensor plantar reflex.
A hypothermia catheter Icy® (Alsius Corporation, Irvine, California) was installed via the right femoral vein.
Intravenous hypothermia was initiated 1 h 30 min after CPA, with an objective temperature of 33o C at a maximum cooling rate.
Objective was achieved 4 h after PCR, maintaining this temperature for 48 h.
Subsequently, rewarming was started at a rate of 0.1o C/h for the first 8 h and then 0.2o C/h to achieve temperature 36oC in approximately 18 h.
During the hypothermia period, the patient had at least 2 episodes of atrial fibrillation, one of which required electrical cardioversion.
Ischemic origin of CPA was ruled out.
Echocardiography showed severe cardiomyopathy systolic dysfunction and dynamic outflow tract obstruction associated with moderate to severe mitral regurgitation.
respiratory failure secondary to severe pneumonia and acute respiratory distress syndrome (ARDS), difficult to manage because it depends on preload to support hemodynamics, intolerance to vasodilators, diuretics PEEP
On the fourth day of evolution, sedation was suspended for neurological evaluation.
The patient presented spontaneous ocular opening, obeyed commands, mobilised 4 limbs, and showed no signs of neurological focality.
On the fifth day, having been maintained on antithrombotic prophylaxis with enoxaparin, it was decided to remove the hypothermia catheter.
Before removal, ultrasound of the right lower extremities and extensive right iliofemoral venous thrombosis were performed.
A study with AngioTAC started and progression of thrombus to intrahepatic vena cava Anticoagulation with low molecular weight heparin was performed.
On the 11 day of hospitalization and given the technical impossibility of installing a vena cava filter caudal to the thrombus, the hypothermia catheter was removed under ultrasound vision.
Control CT angiography showed small right subsegmental pulmonary thromboembolism (PTE).
Heparin anticoagulation was administered.
1.
Successful extubation day 25 progressing to a basic hospital for implantable mesh and continuing to study underlying heart disease for eventual surgical resolution.
