Favourable outcome after 26 minutes of "Compression only" resuscitation: a case report

CASE PRESENTATION: A 49 year old man had ventricular fibrillation in his home, at room temperature, due to an ST-elevation myocardial infarction. He received Cardiac compression only resuscitation (CC-only) for 26 minutes by his wife, followed by four minutes of standard CPR by other lay persons until EMS-arrival. Gasping and moaning were observed during most of the CC-only period. The ambulance arrived at 30 minutes. The first ECG showed a fine ventricular fibrillation. Restoration of spontaneous circulation (ROSC) was achieved at 49 minutes after a total of four defibrillatory shocks. The patient recovered without any cerebral damage, and was discharged to his home after eight days hospitalization. CONCLUSIONS: This case demonstrates that early and powerful cardiac compressions alone without rescue breaths may maintain sufficient circulation and gas exchange to prevent neurological damage for more than 25 minutes. This should be kept in mind for Emergency Medical Dispatch Centrals giving Pre-arrival instructions to bystanders.