Journal of Emergencies, Trauma, and Shock
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Year : 2021  |  Volume : 14  |  Issue : 2  |  Page : 118-119
A successful outcome in a case of cardiac arrest due to drowning with severe acidosis


Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizuoka, Japan

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Date of Submission23-Nov-2020
Date of Acceptance15-Dec-2020
Date of Web Publication27-Apr-2021
 

How to cite this article:
Yanagawa Y, Jitsuiki K, Kushida Y, Omori K. A successful outcome in a case of cardiac arrest due to drowning with severe acidosis. J Emerg Trauma Shock 2021;14:118-9

How to cite this URL:
Yanagawa Y, Jitsuiki K, Kushida Y, Omori K. A successful outcome in a case of cardiac arrest due to drowning with severe acidosis. J Emerg Trauma Shock [serial online] 2021 [cited 2021 Jul 31];14:118-9. Available from: https://www.onlinejets.org/text.asp?2021/14/2/118/314957




Sir,

A 28-year-old woman who traveled to Izu Peninsula from Tokyo as a tourist drowned while undertaking diving training in the sea. The diving instructors noticed her accident and rescued her from the sea floor, at a water depth of 2 m. She was moved to the nearby shore, which she reached at 12:20, within a few minutes after the accident occurred. As she was in a state of deep coma with apnea, chest compression was performed. Automated external defibrillation was also performed, with the patient receiving one electric shock. When emergency medical technicians checked her at 12:34, she was in cardiac arrest. The initial rhythm was a pulseless electrical activity. She was transported to our emergency room by an ambulance; during transportation, she received chest compression, insertion of a supraglottic airway, and ventilation. She had no relevant past or family history. On arrival at 13:00, she remained in a state of cardiac arrest with dilated nonreactive pupils (both 8 mm). She underwent tracheal intubation, mechanical ventilation, securing of a venous route, and infusion of adrenaline (1 mg). At 13:07, a return of spontaneous circulation was achieved. On arrival, an arterial gas analysis, under 15 L/min of oxygen, revealed the following findings: pH, 6.52; PCO2, 97.3 mmHg; PO2, 89.4 mmHg, HCO3, 7.6 mmol/l, lactate, 22 mmol/L, and base excess,−37.2 mmol/L. Portable chest roentgenography revealed bilateral decreased radiolucency of the lung fields. Electrocardiography showed sinus tachycardia without ST change. Her vital signs at 13:10 were as follows: blood pressure, 134/54 mmHg; heart rate, 92 beats/min; respiratory rate, 14 breaths/min, and core temperature, 33.3°C. At 13:13, she showed generalized convulsions. Thus, infusion of 10 mg of diazepam and 500 mg of levetiracetam and continuous infusion of midazolam were initiated. Whole-body computed tomography showed preservation of the cortical ribbon, an abnormal mixed density lesion at the left posterior temporal lobe of the brain, and diffuse decreased density of the bilateral lung fields [Figure 1], which were compatible with aspiration. The main results of a biochemical analysis of blood were as follows: white blood cell count, 13,500/μL; glucose, 359 mg/dL; sodium, 163 mEq/L; potassium, 4.6 mEq/L; chloride, 134 mEq/L; calcium, 12.5 mg/dL; and fibrin degradation products, 395.6 μg/mL. These laboratory results were compatible with drowning in seawater and severe hypoxic insult. She underwent induced hypothermic therapy for 24 h, with a target core temperature of 33°C. After finishing rewarming, she was able to obey orders. After observing improvement in her respiratory function with a PaO2/FiO2 ratio of >300, she was extubated on day 3. Head magnetic resonance imaging on the same day demonstrated cavernous hemangioma with hemorrhage and thin subdural hemorrhage. This cerebral insult was thought to have been responsible for her drowning incident. On the 11th day, she was transported to Tokyo without neurological deficit for further examination of the cerebral cavernous hemangioma.

A chain of survival, including accidental hypothermia and extended induced hypothermic therapy, may contribute to the achievement of a favorable outcome, even if a patient shows convulsions and unfavorable biochemical–hematological data.[1],[2],[3],[4],[5]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her image and other clinical information to be reported in the journal. The patient understands that her name and initial will not be published and due efforts will be made to conceal her identity, but anonymity cannot be guaranteed.

Acknowledgment

This work was supported in part by a Grant-in-Aid for Special Research in Subsidies for ordinary expenses of private schools from The Promotion and Mutual Aid Corporation for Private Schools of Japan.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Corral Torres E, Hernández-Tejedor A, Suárez Bustamante R, de Elías Hernández R, Casado Flórez I, San Juan Linares A. Prognostic value of venous blood analysis at the start of CPR in non-traumatic out-of-hospital cardiac arrest: Association with ROSC and the neurological outcome. Crit Care 2020;24:60.  Back to cited text no. 1
    
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Takasu A, Sakamoto T, Okada Y. Arterial base excess after CPR: The relationship to CPR duration and the characteristics related to outcome. Resuscitation 2007;73:394-9.  Back to cited text no. 2
    
3.
Ono Y, Hayakawa M, Maekawa K, Kodate A, Sadamoto Y, Tominaga N, et al. Fibrin/fibrinogen degradation products (FDP) at hospital admission predict neurological outcomes in out-of-hospital cardiac arrest patients. Resuscitation 2017;111:62-7.  Back to cited text no. 3
    
4.
Tagami T, Hirata K, Takeshige T, Matsui J, Takinami M, Satake M, et al. Implementation of the fifth link of the chain of survival concept for out-of-hospital cardiac arrest. Circulation 2012;126:589-97.  Back to cited text no. 4
    
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Suen KF, Leung R, Leung LP. Therapeutic hypothermia for asphyxial out-of-hospital cardiac arrest due to drowning: A systematic review of case series and case reports. Ther Hypothermia Temp Manag 2017;7:210-21.  Back to cited text no. 5
    

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Correspondence Address:
Youichi Yanagawa
Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizuoka
Japan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JETS.JETS_174_20

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