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comprehension and social interaction. After
improving his strength and endurance from the
prescribed course of rehabilitation, he was discharged with no focal neurologic weakness other
than a slightly unsteady gait and was able to ambulate without assistive devices.
The total time from 9-1-1 call to UCSF transfer
was just a little over eight hours! The pieces of
this story not documented here are the personal
interactions and emotions of those involved with
the laborious care of this patient in the cardiac
One week following this case, a multidisciplinary
debriefing was conducted including leadership
from EMS, ED, catheterization lab, OR and ICU.
The insight from the debriefing dialogs made it
clear that leadership from the catheterization lab
facilitated multiple services within the hospital to
come together for the good of the patient.
Highland Hospital has the reputation of being on
the forefront of the most current and cutting-edge
medicine with its renowned residency programs.
In 2016, Highland had three patients go to the
cardiac catheterization lab for PCI with active resuscitation (i.e., mechanical CPR) that survived to
hospital discharge with good neurologic function. This further demonstrates their leadership
and commitment as a community champion to
improving patient outcomes.
Even though this case may be perceived as an
outlier and an exception to the rule, it strongly suggests that it does take a fearless scientific community working together on behalf of the patient to
achieve the unexpected. This case exhibits what we
may have found to be the next frontier in cardiac
arrest resuscitation, prolonged care with mechanical compressions and the application of ECMO. ✚
Michael J. Jacobs, EMT-P, is the manager for Alameda
County (Calif.) EMS Specialty Systems of Care, including
education and research related to cardiac arrest, STEMI,
stroke, trauma and CPR in schools. He’s also an EMS consultant for Coastside Fire Protection District in San Mateo
County and a clinical education consultant for Stanford
Karl A. Sporer, MD, FACEP, FACP, is the EMS medical
director for Alameda County and professor emeritus of
emergency medicine at the University of California, San
Francisco. He can be reached at email@example.com.
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