An exceptional case of complete neurologic recovery after more than 5-h cardiac arrest

We describe a case of more than 5 h cardiac arrest in a 60-year-old patient who underwent general anesthesia for a urologic operation. Before extubati on, the patient suddenly developed ventricular fibrillation, pulseless vent ricular tachycardia and asystole which was immediately treated by advanced life support (ALS) measures. Thirty minutes later seizures developed and we re controlled by 200 mg of thiopentone and 10 mg of diazepam. A pattern of ventricular tachycardia, coarse ventricular fibrillation and asystole laste d for nearly 120 min. Termination of resuscitation maneuvers was considered . but long-term life support was continued for 5 h. After this time, periph eral pulses. with a supraventricular tachycardia-like rhythm and regular sp ontaneous breathing reappeared. Seven hours later, the patient had a Glasgo w Coma Scale (GCS) of 5. dilated unresponsive, absence of pupils, and a sys tolic arterial pressure of 100 mmHg. He was then transferred to intensive c are unit (ICU). The morning after the patient was awake, responded to simpl e orders, breathing spontaneously, and free from sensomotor deficit. He was , therefore, extubated. Subsequently, other episodes of transitory ST-line upper wave follow-ed by ventricular fibrillation appeared, suggesting Prinz metal angina. This was successfully treated by percutaneous coronary angiop lasty. The first electroencephalogram recorded the day after cardiac arrest showed a mild widespread background slowing. An electroencephalogram 6 day s later showed a return to alpha rhythm with only mild theta-wave abnormali ties. Four weeks after the first cardiac arrest the patient was discharged. This is an exceptional experience compared with the others reported. We be lieve that all the efforts must not be given up when such an event occurs d uring anesthesia and there are optimal conditions for resuscitation maneuve rs. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.