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CPR certanily can be effective enough to maintain even cortical circulation. 

What convinced me of that, within reason, the harder the better for compressions, was a big burly ED tech I worked with some years ago . It was shortly after the advent of thrombolytics being introduced for STEMI. Literally as the nurse was injecting the thrombolytic into a big, middle aged man he arrested. Given the situation, we worked him as hard as anyone with our burly tech doing compressions like no on I had ever seen. Just as we were getting ready to call it he returned to spontaneous sinus rhythm and woke up. 

After I complemented our tech he related the story of doing compressions on a lady in the ICU a while before our episode. In that situation the physician repeatedly had to have him stop his compressions because the woman kept waking up and they needed to shock her! 

So he would stop. Circulation would stop. And she would become unconscious again. Then they could shock her. It evidently took several attempts to get her into a sustainable, spontaneous rhythm so he had to stop several times "to put her back to sleep". 

This was years before the AHA finally began to emphasize deep compressions. 

Geoff R. 

Geoffrey L. Ruben, MD, MMM, FACEP, FAAP 
Clinical Assistant Professor of Emergency Medicine 
West Virginia University School of Medicine 

----- Original Message -----

From: "kplatt6" <[log in to unmask]> 
To: [log in to unmask] 
Sent: Wednesday, February 25, 2015 7:57:39 PM 
Subject: Re: Just when you thought you've seen it all... 

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 
> 
> 
> 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 
> 

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 


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