Prolonged CPR: Why It Works

by Elizabeth Shaw -

CPR for How Long?A man in Ohio recovered after doctors declared him medically dead. This demonstrates the grey area in deciding when to stop efforts to resuscitate a victim.

Yahle, a diesel mechanic from West Carrollton, Ohio, went into cardiac arrest Aug. 5. He was rushed to the hospital where a team of physicians began administering chest compressions and forced blood and oxygen into his body through a breathing tube connected to a bag.  Despite this, he was showing no signs of life, and so after 45 minutes, they declared him dead.

“He was truly flatlined at the end of that code. He had no electrical motion, no respiration, and no heart beat, and no blood pressure,” Jayne Testa says, the director of cardiovascular services at Kettering.

However, 5-7 minutes after declaring him dead, the doctors noticed “a trace of electrical activity on his heart monitor and resumed their efforts to resuscitate him. Yahle is now home recovering.”

Testa said, “While Yahle was not dead for 45 minutes, the Kettering doctors have never seen somebody come back after the code was ended and especially after so many minutes.”

Michael Sayre, a professor of emergency medicine at the University of Washington in Seattle says, “he has seen and heard of similar cases. It’s unusual but not unique. He doesn’t know what happened in Yahle’s case, but sometimes during resuscitation air gets trapped and pressure builds in the lungs, preventing blood from flowing into the heart.”

“So, I have seen once or twice where we would disconnect the bag from the breathing tube and push on the chest to let the air out, and then the patient would get a pulse and have a blood pressure because they were able to get blood back to the heart,” says Sayre.

Sayre  says that it would be advisable for more hospitals to follow in Kettering’s footsteps and continue resuscitation efforts for longer than the usual 20-25 minutes. A nationwide study of hospitals from 2012 reported that “in the hospitals where they worked for longer, they got more people back, who ended up surviving and going home,” says Sayre.

Many hospitals can use the aid of technology to help them make the decision of when to stop resuscitating. Technology can help a team decide when to stop. Most hospitals are not able to measure the amount of carbon dioxide that is in the air being exhaled by the patient. If there is no carbon dioxide in the air coming out, it can be added to the conclusion that the patient is dead.

“However, you can be faked out,” says Sayre.  “Sometimes even with fairly normal carbon dioxide levels, a team will stop resuscitation because we still cannot get the heart to beat on its own.”

But in Yahle’s case, doctors were finally able to get his heart to beat spontaneously.

Luckily for Yahle, the team of doctors at Kettering had the ability to resuscitate him fully. “This team did a really good job. They were able to keep his brain alive, and that’s why he survived,” says Sayre.

One thing that may have preserved Yahle’s brain function is the fact that the doctors cooled his body. “People can definitely go seven minutes without blood flow if the brain is cooled. That is something that is well known,” says Sayre.

So, how long should you continue to do CPR?

Source: NBC News

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