In the rooms of a tourist hotel, he was teaching a course of basic life support and external semi-automated tutor (BEMICYUC) of the National Plan for CPR.
There were teaching DESA teams and a real team that always takes care to take the courses.
During the pause for lunch, the hotel staff came anxiously asking for help to attend to a client who had unconsciously collapsed in a corridor.
The teaching team and the students of the course moved to the place with the real ASD, confirmed unconsciousness, asked to notify the 1-1-2 sequence guided and initiated a cardiopulmonary resuscitation (CPR).
After the fifth attempt, the patient developed spontaneous cardiac activity in sinus rhythm (SR), with several conduction disorders.
A mobile advanced life support unit (AVR) arrived more than 15min after the warning and took care of the situation, witnessing two new cardiac arrests in ventricular fibrillation (VF), the first reversed shock of new Lidocaine.
The ALS unit continued the resuscitation protocol with external cardiac massage, ventilation after orotracheal intubation and administration of atropine.
Several minutes later, a new episode of VF that was transformed into stable RS with a new shock was recorded.
The total duration of resuscitation efforts exceeded 50min and the patient had mydriatic and reactive pupils, so that, before starting the transfer to a tertiary teaching hospital, the doctor of the institution recorded them all.
Upon arrival to the hospital emergency department, the medical team of the coronary care unit confirmed the very poor prognosis, ruling out admission, as was also done by the team of the intensive care unit, so the patient was informed to the hospital emergency room.
The discouragement continued among the students attending the course, but the teaching team reminded them that all links in the chain of survival had been correctly fulfilled, so the prognosis should not be unfavorable.
They also remembered that early neurological signs have no predictive value after the initial recovery from cardiac arrest, especially in the presence of drugs such as those administered.
After completing the course at 9 p.m., the attendants went to the hotel staff to collect updated information.
The environment was very optimistic because the interpreter had communicated shortly before the situation had changed, since the patient had awakened, appeared to be radical, had a catheterization laboratory and had been admitted or had a coronary artery implanted.
A few days later the patient was discharged from the hospital and repatriated to his place of origin, with complete recovery of his mental functions, and he had left in the hotel acknowledgment for those attending him.
Despite the result, the hotel rejected a proposal for the placement of an ASD in its facilities and training of all its personnel in BVS+DESA.
Factors affecting survival of out-of-hospital cardiac arrest are clearly identified and summarized in the scrupulous compliance of all links in the survival chain1.
The very recent update of the European Resuscitation Council recommendations for resuscitation has reminded us once again that early identification and immediate performance of quality CPR followed by SVA continues to be the best way to attempt resuscitation2.
These recommendations have also reminded us that there are no clinical signs to reliably predict a poor neurological prognosis before 24 hours after cardiac arrest, especially in the absence of predictive factors such as corneal drugs or pupillary reflexes only 723.
Emergency medical teams and hospital units should, therefore, correspond to the efforts of witnesses, or the first participants, with an optimization of the techniques of SVA establishment and post-scientific evidence-based treatment, especially for the shortcoming.
And, above all, special care should be taken not to attribute to good sweating what can only achieve orthodoxy in resuscitation.
1.
J.A. Álvarezh Canarias, de laza,b y J.F. Cabrera-Torresb aService of Intensive Care and Emergency, Hospital USP La Colina, Isla Santa Cruz de TenSUeri
