The patient had suffered intense chest pain at home followed by a sudden cardiac arrest and was brought to the hospital in around 20 minutes.

Kauvery Hospital
Product Health Wednesday, April 28, 2021 - 08:49

A 27-year-old man was brought to Chennai’s Kauvery Hospital Emergency department with no signs of life; he had suffered intense chest pain at home followed by a sudden cardiac arrest. It took around 20 minutes to get him to the hospital. Kauvery Hospital successfully revived this young victim of “out of hospital cardiac arrest (OHCA)” which carries a very grim prognosis.

OHCA refers to the ceasing of cardiac mechanical activity that occurs outside the hospital and is confirmed by an absence of signs of circulation. The team immediately started Advanced Cardiac Life Support (ACLS) resuscitative measures; he received emergency electrical cardioversion (shocks) with no reversion to normal rhythm; his chances of survival were remote, with high likelihood of brain damage leaving him in a vegetative state, which is the global experience under such circumstances. 

“The patient was brought to the emergency room, having already passed the window of opportunity to receive treatment that can hope to achieve any likely revival back to life. He was pulseless; his pulse, breathing, BP and oxygen level could not be recorded. While receiving vigorous and continued cardiac resuscitation, he was immediately transferred to the Hybrid Cath Lab. Emergency V-A ECMO support (Extra Corporeal Membrane Oxygenator) was initiated in no time. The ECMO instantly started supporting the functions of the lung and heart, with its pump outside the human body, which maintained the blood flow and delivery of oxygen to the vital organs – the brain, the kidney and the liver etc,” said Dr Manoj Sivaramakrishnan, the attending Senior Interventional Cardiologist at Kauvery Hospital. 

“While the patient remained in cardiac arrest, ECMO assisted in successful high risk angioplasty and stenting with a bioresorable coronary scaffold (dissolving stent - another novel treatment in heart disease) that re-canalised (opened) the 100% blocked artery, restoring normal flow to the heart. He was looked after by the multi-disciplinary critical care team; the ECMO support was removed after three days and much to everyone’s surprise and delight, this young man sprung back to normal conscious state, with no trace of brain defect or paralysis,” Dr Manoj added. 

After four days, he suffered another heart attack which was also successfully treated. His heart function recovered from initial 20% to a near-normal 55%.

Patient was likely in a state of suspended animation which could explain his zero brain injury, according to Dr Manoj. He said this is an instance that highlights the fact that timely resuscitation and ECMO supported resuscitation - eCPR–are central to, and crucial, in the management of victims of cardiac arrest. None should be sent away without immediately initiating life support resuscitation when brought with a history of short period of unresponsiveness. 

Speaking about this successful treatment, Dr Aravindan Selvaraj, Co-Founder and Executive Director, Kauvery Hospital said, "More awareness needs to be created on responding to sudden cardiac arrests. Lot of them do not know what should be done and end up losing their near and dear ones. It is very critical to contact an ambulance service or commute to the nearest hospital to get the required medical intervention within the stipulated time.”