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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 
for you!).

As to explanations, I haven't a clue. Damndest thing.

Ken Platt


On 2/25/2015 7:05 PM, Niel Miele wrote:
> Group:
>       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?
>   
> Niel
>
>   		 	   		
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For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
                 http://listserv.brown.edu/ped-em-l.html