There are approximately 300,000 out-of-hospital cardiac arrests per year with less than 10% of those surviving. More than half of survivors suffer permanent neurologic deficits. Therapeutic hypothermia has proven effective at thwarting neurologic damage occurring in the 16-hour window following return of spontaneous circulation (ROSC). Despite recommendations by the American Heart Association (AHA), many cardiologists have been slow to implement therapeutic hypothermia. While many trials have discussed the relevance of initial rhythm and delay of cooling, there has been limited discussion of the efficacy of therapeutic hypothermia in the presence of extended pulselessness.
A 40-year-old male with past medical history of an ST-segment elevation myocardial infarction 8 years prior, presented with an out-ofhospital cardiac arrest. Cardiopulmonary resuscitation was immediately initiated. The patient remained in ventricular fibrillation for 50 minutes with only one episode of a momentary pulse prior to persistent ROSC.
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