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Posts Tagged ‘cpr’

Human beings can defy fate  in a regular fashion as the  modern science is exploding and creating   infinite possibilities !

  • We can give a fresh  life to a dying man by  multiple organ transplants just like changing  a crashed mother board in a PC !
  • We can isolate vital germ cells , fuse them, clone them and even  create new form of life !
  • We can  keep a man in deep coma  for years and bring back to life !

Still , a sudden cardiac death that happens in a remote place in an unexpected manner is still in the God’s domain ! Cardiac arrest and sudden cardiac death is the  most common mode of acute human loss in our planet .(Read a link :Ignorance based cardiology )

When  the heart goes for convulsions due to electrical  instability , the only solution is immediate  CPR followed by electrical shock .All you require is about 200 j of electrical energy over the chest .This is to achieved within 5-10 minutes.How and where do you get that energy in that short time span ? Is 911/108 services that efficient ?

*Can your fully charged  mobile phone  deliver it ?  Unfortunately not yet !

Public access AEDs (Automatic external defibrillator) are there in many  commercial places.But ,they are not  universal and foolproof.

Come 2015, we have a marvel of a technology waiting  to happen !

How about delivering  a light weight  defibrillator through a drone  ?   to the exact place where it is needed .With the accuracy of GPS  technology  steadily improving , a self powered , auto- responding drones from a near by base station  is a reality .

flying defibrillator aed sudden cardiac cpr

This drone . . . delivers life !

All that is required is a phone call . The drone with defibrillator is  delivered  in few minutes .Of course , a bystander help is required .An experimental pilot project is being tried in Holland What a break through it could be when  its stream lined ?

Man proposes ,God  disposes ” so sure it is !  Are we close to challenge the super power ?

It is said , modern men will play god in near future with perfection.Can it ever be like this ? “God proposes and  man disposes ?  No . . . it can never be!  If a drone comes from nowhere to save a human life, it is also an act of God ,through a   “Human enriched  technology.

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When  a life leaves the body  silently in CCU , an  undulating  flat line in the monitor has a hidden scientific tale  to tell !

 

A  56 year old obese women died a instant death immediately after engaging the Left main ostium  after first injection of 5cc dye. The monitor showed only  a short pause, few sinus beats , a long pause , asystole and death . In the last 2 minutes of survival she threw a random wave forms of suggesting EMD . At any point of time she never showed any evidence for ventricular fibrillation . 1o minutes of intense resuscitation failed that included temporary pacing , repeated shocks  and ventilation.(ECMO /LV assist excluded)

asystole_bad_day_in_the_cath_lab_tshirt-p235709389664476041uye8_400

What is the mechanism of death ?

  • Is it electrical or mechanical ?
  • Acute mechanical stunning / the stone heart ?
  • Is it a primary electrical asystole ? (Acute sinus arrest or AV block )

Post hoc analysis of CAG did not show any significant clues except a tight distal left main.Apparently the catheter has triggered the event .( Or is it the  dye ? as some body suggested it as anaphylaxis  ?)

Even though we conveyed the message to the relatives,  it’s was an unexpected massive heart attack , obviously we were not convinced with our  uttering  ! Mind you , she had  normal LV function but had recurrent angina prior.

asystole ecg 004

Image courtesy modified from http://www.ijaweb.org 2012 for representation purpose only.

We know if cardiac arrest is due to VF, it tends to give us  at-least some time and sense. Further,the VF protocols are more clear and success rate is more .

There is always an issue of  fine VF vs  asystole.If the flat line is indeed VF , there is more chance of revival as we try to pump adrenaline to make the fine VF  into coarse one  and shock again .The sequence can continue few times.

It is well known  asystole has a  dismal outcome .Even among the asystole there is some hope* if asystole is purely   electrical . (Like Stokes Adams in CHB or electrolytic asystole like hyperkalemia etc ) .But if asystole is due  mechanical cause , death ensues in spite of prompt temporary pacing .

* Important note : We have this  common  form of  treatable  mechanical asystole .It is called cardiac tamponade .It always present  with extreme bardycardia and asystole. It is extremely  rare to see a tamponade to present with VF. A prompt needle tap will do the job .It is vital  to recognise this in cath lab as our efforts are rewarding .

I would recommend a hand held echo machine , to hang like a catheter in every cath lab , ready to screen unexplained cardiac arrests with zero delay !

Why some hearts respond with VF  , while others go for asystole  with acute coronary insult ?

  • A million Rupee question ! We are yet to find a legible answer .What is probable is  the the heart doesn’t  even have energy to fibrillate !
  • The underlying disease need to be so intense .In this case it was left main stenosis supplying a truncated LAD and LCX. We could also see it supplying twigs to RCA  suggesting it to be a total occlusion .
  • So ,when a  “physiologically single” coronary artery that precariously  supply the entire heart is suddenly insulted the heart behaves violently with runs of VT/VF. Our ignorance is complete when we realise  the heart  can do the opposite as well .It does not react at all , goes for a deep slumber and result in electro-mechanical sudden death.
  • It is expected , in acute mechanical  deaths one may encounter flash pulmonary edema if the LV alone gets stunned. However , if both right and Left ventricle come to standstill in a synchronised sudden fashion , lungs will be as silent as deep sea . We believe this is what happened in our patient and it can be logically correlated  as  the critically narrowed left main was supporting the  RCA  as well.

Final message

Sudden cardiac deaths  9 out of 10 times is electrical . Majority  of them is  due to fibrillation. Next comes the electrical asystole ,Rarely (is that really rare ?) an ultra fast  sudden death due to mechanical asystole (Non -Tamponade ) is  possible , as experienced in our patient .

These mechanical asystole  are yet to be decoded.Whether it is a form  of Acute stunning , electro -mechanical uncoupling or mechano electrical standstill is not clear.

 

 

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In 1960 , exactly 50 years ago , a group of doctors from Jhon Hopkins published their observation in 20 cases. It went on to become , one of the most remarkable discovery  in the history of cardiology .

They taught us how to use  a pair of hand  ,  as an  artificial  heart and save lives

They are . . .

  1. Dr Kouwenhoven*
  2. Dr  James R. Jude, and
  3. Dr G. Guy Knickerbocker .

* He was not a medical doctor but an electrical engineer at Hopkins but he worked in the medical school as well .

They meticulously documented , each patient’s case history ,  whom they were able to successfully revive , (It was in the same  period , the  AC/DC shock was also invented  in the  Hopkins ) .One of  the  highlights of their paper was ,  with each chest compression  they were  able to elevate the carotid pressure  up to 90mmhg and was recorded in a pressure tracing .

We have to thank the  JAMA (Journal  of American medial   association )  for  making this  original  article   available  free in their website .

Must read for every cardiologist

http://jama.ama-assn.org/cgi/reprint/173/10/1064?ijkey=33bb40fe3062331bae50e10c8a04263f3e26b317

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Can  modern technology  bring back  the life from a   dead person ?

Yes it is possible  ,  not in the near future !  but  in the present era  . . .

This revolutionary new portable heart lung machine may just do that .

Imagine  this scenerio : A cardiac arrest  victim  – failed resuscitation  with  ACLS  ,   the patient  needs  to be taken for an emergency cardiac surgery or intervention .You need time at least ,  few hours .Till that time  this simple device   takes  over the  role  of GOD    i e  sustaining life   by   pumping  and oxygenating  6 liters of blood !

Learn more about this award winning wonder machine from lifebridge .Germany

LIFEBRIDGE Medizintechnik AG / Product / LIFEBRIDGE B2T®

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