SHM Converge Scientific Abstract ePoster Gallery-Defying the Odds: Effective CPR Achieves Remarkable Neurologic Preservation After Prolonged Cardiac Arrest

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This case report describes a 45-year-old woman with multiple sclerosis and morbid obesity (BMI 53) who developed dyspnea after immunotherapy and was found to have bilateral lower lobe pulmonary emboli plus a saddle embolus with right heart strain. She underwent suction thrombectomy but then suffered a pulseless electrical activity arrest.<br /><br />Manual CPR was started immediately, and she was intubated 12 minutes later. Because of her body habitus, robotic/mechanical compressions could not be used. Despite prolonged resuscitation, including transient return of spontaneous circulation episodes, she achieved full ROSC after 70 minutes. During the code, she received 13 doses of epinephrine and 4 doses of sodium bicarbonate.<br /><br />Her hospital course was complicated by renal deterioration requiring hemodialysis, but she stabilized hemodynamically after five days. Remarkably, she regained cognitive function and full motor ability within 10 days and was discharged after 28 days.<br /><br />The report emphasizes that high-quality CPR can lead to excellent neurologic outcomes even after very prolonged cardiac arrest, challenging assumptions that extended resuscitation is futile. It reinforces strict adherence to CPR guidelines: compressions at least 2 inches deep, 100 to 120 per minute, full chest recoil, minimal interruptions, pulse checks every 2 minutes, and the standard 30:2 ratio with proper airway maneuvers.<br /><br />The discussion notes that while evidence suggests neurologic outcomes generally decline with longer CPR duration, this case shows that favorable recovery is still possible when CPR is effective and persistent. The authors call for ongoing training and future studies to identify predictors of good neurologic recovery and to evaluate the role of mechanical compression devices.

Asset Subtitle

Joshua Tsai

Meta Tag

Author List Hemantkumar Raval, Joshua Tsai, Juan Carlos Rivera-Martinez, Mason Grimm, Sophia Elortegui

Category Clinical Vignettes

Concept Cardiopulmonary Resuscitation

Concept Chest Compression

Concept Pulmonary Embolism

Concept Neurologic Recovery

Concept Neurological Function

Distinguished Non-Finalist

Presenter Organization Lakeland Regional Health

Presenting Author Joshua Tsai

Track Adult

Keywords

pulmonary embolism

saddle embolus

pulseless electrical activity

cardiopulmonary resuscitation

manual CPR

right heart strain

suction thrombectomy

morbid obesity

neurologic recovery

mechanical chest compressions

Cardiopulmonary Resuscitation

Chest Compression

Pulmonary Embolism

Neurologic Recovery

Neurological Function