SUCCESSFUL MYOCARDIAL REVASCULARIZATION AND NEUROLOGIC RECOVERY IN A PATIENT WITH PROLONGED REFRACTORY CARDIAC-ARREST AND A CHRONICALLY OCCLUDED LEFT INTERNAL CAROTID-ARTERY

Heretofore, the longest successfully treated cardiac arrest reported i n the literature, secondary to myocardial ischemia, was one that requi red 45 minutes of cardiopulmonary resuscitation before coronary bypass surgery. We present a unique case of successful resuscitation after a cardiac arrest secondary to myocardial ischemia. The arrest lasted 78 minutes (30 minutes of closed cardiac massage and 48 minutes of open cardiac massage). As soon as a perfusionist was available, cardiopulmo nary bypass was initiated. After completion of the distal anastomosis and upon removal of the aortic cross clamp, the patient spontaneously recovered sinus rhythm for the 1st lime since her cardiac arrest 2 hou rs and 10 minutes earlier This 70-year-old woman, with a history of ch ronic occlusion of the left internal carotid artery, recovered fully w ithout evidence of neurologic or myocardial insult. We believe that vi gorous closed and open cardiac massage, followed by cardiopulmonary by pass and the correction of myocardial ischemia, enabled this patient t o survive a prolonged refractory cardiac arrest.