When a 54-year-old man collapsed outside a grocery store on a cold winter's night in rural Minnesota recently, a bystander and a trained first responder who happened to be nearby came together to administer CPR.
Five minutes later, paramedics arrived, continued the CPR, and over the course of the next half-hour delivered six defibrillation shocks.
Then a Mayo Clinic flight crew arrived by helicopter, and they proceeded to administer advanced CPR on the still-pulseless patient. After delivering a total of 11 shocks, the team still couldn't get a pulse, so they upped the drugs, did CPR for two more minutes, and delivered the final, twelfth shock.
It was at this point that a pulse gradually returned, and the crew flew the patient to St. Mary's Hospital in Rochester, Minn. The team calculated that this man had no detectable pulse from the moment he collapsed to the gradual return of a faint pulse an astonishing 96 minutes later.
In most people, this means death, or in the best of circumstances, some level of brain damage. But the folks at the Mayo Clinic attribute this man's survival and full recovery to two important factors: effective CPR by several team members and the assistance of a key piece of technology not often used by emergency personnel treating cardiac arrest: capnography.
"Compressing the chest in a cardiac arrest victim is a very fatiguing process, and it requires a fresh rescuer to rotate," Mayo Clinic anesthesiologist and cardiac care specialist Dr. Roger White said in a statement. "And that's what we had available to use--people who were able to help us to continue this effective chest compression effort."
Capnography, which is more frequently used in operating rooms, measures the concentration of carbon dioxide (which provides information on blood flow) through the lungs, which then goes on to other organs. It was because this man's measurements remained sufficiently high that the emergency team stuck with CPR for such an unusually long amount of time.
"The effort was successful in large part because of capnography, which informed emergency workers that if they persisted, it was conceivable they'd have a survivor on their hands," said White, who reported on the usefulness of capnography in this way in Mayo Clinic Proceedings in April.
After the patient was flown to St. Mary's Hospital, he spent a few minutes in the emergency department and was then taken to the cardiac catheterization laboratory. Over the next 10 days, he recovered from several adverse effects and went home "neurologically intact."
"To our knowledge, this episode is the longest duration of pulselessness in an out-of-hospital cardiac arrest that ended with a good outcome," White reports. "The case suggests further study of advanced life support techniques is warranted, as well as the use of real-time technology like capnography that can validate the efficacy of resuscitation efforts."
Following this harrowing ordeal, the patient then underwent a coronary bypass operation to correct the remaining coronary artery disease. Again, he recovered completely.