9-1-1 Call Cath lab Mechanical CPR ECMO
Aspirin, normal saline,
O2, nitroglycerin, Zofran (ondansetron),
intervention, balloon pump,
pacer, nine defbrillations
Figure 3: Timeline of 52-year-old witnessed cardiac arrest
patient using mechanical CPR as a bridge to ECMO
Once UCSF agreed to accept the patient and
respond with their ECMO team and equipment,
Highland Hospital’s catheterization lab director
knew that the lab needed to become an OR as well
as an ICU until the patient was successfully on
ECMO and en route to UCSF.
After the patient started to deteriorate, the ED
was called to secure the patient’s airway by intubation. Anesthesia was called in to manage oxy-genation/ventilation as well the sedation of the
patient during the resuscitation efforts.
An OR team came and prepared the catheterization lab for the surgical procedure of large bore
arterial/venous cannulation for ECMO. An ICU
physician and nurse came to the lab to monitor
and manage hemodynamics and metabolic support
needed throughout the prolonged resuscitation.
Once the UCSF ECMO team arrived, an additional time challenge was overcome—the emergent
granting of clinical privileges for visiting non-Highland faculty.
The ongoing struggle throughout the entire
resuscitation was keeping the batteries of the
LUCAS device charged. The initial power drain
from hour after hour of continuous chest compressions wouldn’t allow for the batteries to charge,
even when plugging the device’s AC adapter into
a wall outlet.
A request for fully charged batteries went out
to the Oakland Fire Department and Paramedics
Plus, and they immediately responded and delivered several spare batteries to the hospital to allow
for continued operation of the LUCAS throughout
the prolonged resuscitation.
After ECMO establishment, the patient was
transferred to UCSF via ambulance, where he
remained on ECMO for seven days with the intention of continued multisystem support.
After a week on ECMO, the patient was extu-bated, his sudation was lightened and he was
weaned from ECMO. He interacted appropriately
and showed good cardiac function. After a brief
in-hospital setback, the patient underwent intensive rehabilitation.
At the time of discharge, the patient pre-
sented with good cognitive return in memory,
Upon ambulance arrival, the patient was found
sitting on a curb with personnel from the Oak-
land Fire Department. He was alert and oriented
to person, place, time and circumstances (A&Ox4).
The patient stated that four hours prior to EMS
activation, he was involved in an argument with a
neighbor and began having sudden, acute shortness
of breath that brought on chest pain and nausea.
The patient rated his pain seven out of 10 and
said he was unable to describe it. He also stated he
had no cardiac history.
The patient’s pulse was 62 and irregular, with
a respiratory rate of 24 and irregular. His blood
pressure was 122/92 mmHg via automated cuff,
SpO2 of 100% on room air. His skin was diaphoretic, lung signs normal and pupils were 3 mm and
reactive. A 12-lead ECG revealed sinus arrhythmia
with frequent multiform premature ventricular
contractions (PVCs). (See Figure 2.)
The patient was emergently transported to
Highland Hospital, which was advised of a possible STEMI.
During transport, the patient became lethargic
and was unwilling to answer further assessment
questions. His vital signs were reassessed throughout contact until he was handed over to the hospital’s ED staff.
During a brief clinical re-evaluation on arrival
in the ED, the patient was found to have a much
lower blood pressure than expected. This warranted the administration of pharmacologic support prior to proceeding to the catheterization lab
for emergent PCI.
Shortly after arrival in the catheterization lab, the
patient went into cardiac arrest and was placed on
the hospital’s LUCAS mechanical chest compression device as resuscitative efforts were carried out.
At the time of this case, Highland Hospital didn’t
have the capability to perform ECMO, so they
contacted the University of California, San Francisco (UCSF) Medical Center, who agreed to dispatch their ECMO team to initiate ECMO care
and transfer the patient to UCSF. The patient was
maintained on a LUCAS device in the catheterization lab while waiting for the ECMO team to arrive.