Summary: A 39-year-old male developed chest pain while at work and then collapsed. A bystander applied an AED and performed CPR for 15 minutes. ROSC was achieved by the time paramedics arrived. ECG performed at a rural hospital showed anterior ST elevation, and thrombolysis was administered. A HEMS nurse and paramedic team were dispatched to transport the patient to a hospital with a cath lab and CCU. During the 1-hour and 40-minute flight, the patient did not reperfuse, and persistent ST elevation was noted. Despite maximal medical therapy, the patient had multiple episodes of pulseless ventricular fibrillation, necessitating 25 defibrillations and periods of CPR. Due to the patient’s unstable status, the supervisory HEMS physician updated the receiving hospital. The Shock Team at the receiving hospital was activated, and appropriate resources were readied for the patient’s arrival. Five minutes before After a brief assessment in the CCU, the patient was transferred to the OR, where ECMO was established under ongoing CPR. The patient was subsequently transferred to the cath lab, where a 100% proximal LAD lesion was identified. A DES was successfully deployed in the LAD. After 3 days, the patient was decanulated from ECMO. He was subsequently extubated and transferred to the ward. Following a 20-day stay in the hospital, the patient was discharged home, ambulatory, neurologically intact, and able to live independently. When the HEMS organization reviewed the case, they recognized the difficulty of delivering prolonged quality CPR in flight and acquired a LUCAS device. This case illustrates the importance of empowering prehospital providers to manage critically ill patients, the value of coordinating with a receiving hospital, and the benefits of clinical audit.
Inwood et al. (Sun,) studied this question.