I had a very similar case, maybe 12 years or so ago. Very memorable.
Also a teenage boy, sudden collapse while cheering his sports team (post
showed myocarditis, presumed viral. He had not complained of anything,
so it was unrecognized). I don't recall the details of the EMS actions
and our code, but just as you described, we had just pronounced him when
he took a breath and moved.
The family was in the room, and for their peace of mind, I restarted the
code and ran it for another 10 minutes or so. My case did not have a
second such event, though. There was never any ROSC or cardiac
electrical activity (at any point during the code including after the
breath and movement). We re-pronounced him (there's an unusual phrase
As to explanations, I haven't a clue. Damndest thing.
On 2/25/2015 7:05 PM, Niel Miele wrote:
> Your opinions on a strange development in a case would be welcome:
> Teenage boy, previously healthy, sickle cell trait, playing basketball collapses
> Found to be pulseless.
> Police on scene apply AED and patient is shocked and remains pulseless
> (I do not know if AED found shockable rhythm)
> EMS arrives documents asystole, secures airway, I/O started, CPR is given, 6 rounds of Epi en route, Amiodarone
> Arrives at hospital approx. 30 minutes of down-time.
> Compressions held to check for rhythm--asystole, ultrasound of heart shows no activity:
> Patient postures (arms extend and turn inward) and takes a breath (inhale/exhale...not stacked breath release)
> CPR and medications continue. Again, stop to check rhythm:
> Patient postures and takes breath
> Pupils sluggishly reactive
> Continues for a total of 30 more minutes, and is ultimately pronounced.
> Autopsy not yet available.
> Do you think that it is possible with effective CPR to have a somewhat functioning brainstem/respiratory drive? Is this some sort of reflex? Any other explanation?
> Also, with no electrical cardiac activity for a prolonged time, would you continue once you saw these movements?
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