A Case of Fatal Asthma: Rapid Transition to Cardiac Arrest and Rapid Recovery of Respiratory Status

The global mortality of bronchial asthma continues to decrease, with a reported 57% decline in age-standardized mortality rates between 1993 and 2006.Asthma may rarely be encountered as a cause of cardiac arrest on arrival in the emergency department these days, especially in high-income countries. Rapid worsening of symptoms and rapid improvement in respiratory status after initiation of treatment have been noted as a hallmark of cardiac arrest due to asthma. A 62-year-old male was admitted to our emergency department after dyspnea and dry coughing attack lasting approximately 15 minutes and resulted in cardiopulmonary arrest. His arterial blood gas analysis showed mixed acidosis with pH 7.00, partial pressure of oxygen (PaO(2)) 184, partial pressure of carbon dioxide (PaCO(2)) 90 mmHg, HCO(3)(-) 22.2, lactate 104 mg/dL. He returned to spontaneous circulation after about 30 minutes of cardiopulmonary arrest. The very slight wheeze on expiration was heard in the left lung and his chest x-ray showed increasing permeability of the lung, which suggested air trapping. Based on his history of asthma, the background of medication discontinuation, and physical findings, the diagnosis of cardiac arrest due to an asthma attack was made. Two hours after admission, PaCO(2) normalized and his respiratory condition stabilized rapidly. However, epileptic seizures due to hypoxic encephalopathy were prolonged. Although he was then managed in the intensive care unit, he was diagnosed with irreversible brain damage due to hypoxic encephalopathy and shifted to palliative care. Asthmatic cardiac arrest is now rare, but still important. And it may be difficult to identify asthma as a cause of cardiac arrest if the respiratory status improves rapidly. Therefore, keeping in mind the presence of asthma cases of rapid deterioration to cardiopulmonary arrest and case of rapid treatment response may lead to a correct diagnosis.