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                Some times in this job you, or at least I get kind of jealous of calls that other crews have run and the treatments they had to perform on said call. It might sound kind of funny, this “medical envy” but I experience it from time to time as I am sure others do too. Well this crew brought in this patient that I could only describe as a “miracle of modern medicine”. Now let me paint you a better picture

                This crew responded to an AARP member age group patient with a chief complaint of shortness of breath. Well this patient was short of breath because they were in V-Tach. No chest pain though which was surprising since there were more surgical scars from previous cardiac procedures on this patient than most people have teeth. At any rate, they do the IV, O2, monitor deal and start the rhythm management with the antiarrythmic flavor of the week. In this area, it happens to be Amio. They get about half way through it and the patient decides to arrest on them. Now this has happened to all of us in EMS before and will happen again. However, whenever it does happen, it is usually followed by a string of obscenities and good CPR.  I am fairly certain that is what this crew did too. Thus only further perpetuating my little theory here.

                Now this would be a routine cardiac arrest call. However, after about a minute or so of ACLS time, the patient wakes up. The patient then goes back into full arrest again about a minute later. Now I know what you’re thinking, and yes you are correct in thinking “WTF?”, I did it too when I heard the story.  This cycle of ROSC, CPR, WTF, repeat continues at the hospital too. And don’t worry, there is plenty more “WTF” to go.

                So obviously a bit surprised by the whole ordeal, the crew and the ER staff now have a pseudo-dead patient on their hands. And the game of “is it PEA or not” continues. In one of the instances of arrest, the patient is intubated by the ED doc and they start pushing all the fun ACLS drugs and start going down the protocol(s). But then, while good CPR is being done the patient starts to move all four extremities and even grimaces with each compression. Good thing they didn’t have the auto pulse. BTW, you probably don’t have to do CPR on a pt if you have to hold down their legs. Just sayin’. But this patient obviously did not have the greatest perfusion so it probably wasn’t the worst idea that was being thrown around in the room.

                The battle between PEA and ROSC continued from the resus  bay to the cath lab. On the way to the lab, multiple pressor agents were started due to the patient’s BP being “almost nothing over I want to go home”. And don’t think that because we made it to the cath lab that we in the clear. The fun had just begun at this point.

                The first initial view thanks to the magic of fluro revealed more stents, grafts, staples, and sutures that I have ever seen in one x-ray. The cardiac silhouette was also the size of a small basketball and had about as much squeeze as a bean bag chair. The doc actually had to access through the mammary artery. Not exactly your traditional cath approach. Neo was also started on this patient too. For those keeping track, that is three pressor agents going. Holy alpha 1 agonists, Batman!

                The cath showed multiple types of badness and that it was way beyond the scope of this hospital to handle. The reservations at the tertiary cardiac center has been made as well as a fast and loud way of getting there. Good thing they have a big truck, because they also decided to throw an IABP into this desperate patient to further complicate the clinical picture here. Not saying it was a bad idea, I am just saying it complicates things from both a medical and a logistical stand point. This was also when the staff discovered that the patients ejection fraction or EF was a whopping 2%. Just for comparative reason, the normal EF in a healthy person is about 60-67% depending on who you talk to. So an EF of basically nothing just further proves my point that this patient was and is a miracle of modern medicine. Additionally, No helicopter was called due to poor weather. However, I am not sure they would have been able to fit everything into the bird.

                So let’s look at what is to be transferred with our poor patient here. Multiple vasoactive drips (4), ventilator since the patient was finally given RSI drugs, the monitor/defibrillator, and the IABP that is the size of your run of the mill desktop computer. That’s a lot of stuff to put in the back of an ambulance, let alone a helicopter. I think for once, the weather was a blessing and not a curse.

                The patient was taken to the super hospital by their CCT team and promptly put on ECMO in hopes of either an LVAD or a completely new heart. Either way, the prognosis is not looking good.