USA: "A 25-Year-Old Man with Coma after Cardiac Arrest"

NEJM, Volume 360:2118-2125 May 14, 2009, Number 20

"Case 15-2009 — A 25-Year-Old Man with Coma after Cardiac Arrest"

Authors: Camille N. Kotton, M.D., Nahel Elias, M.D., Francis L. Delmonico, M.D., and Richard L. Kradin, M.D.

Presentation of Case

Dr. Mathias Lichterfeld (Infectious Disease): "A 25-year-old man was admitted to this hospital because of coma after cardiac arrest."

"He had been well until 4 hours before admission, when he was seen to have had seizurelike movements and to have collapsed, without pulse or respirations. Emergency medical services was called and arrived approximately 7 minutes later. Examination disclosed ventricular fibrillation. Cardiopulmonary resuscitation, including the administration of epinephrine and atropine and electrical defibrillation followed by the administration of lidocaine, was performed; a junctional cardiac rhythm was established after 4 minutes. The patient remained hypotensive and unconscious." (...)

Source Information:

From the Infectious Disease Unit (C.N.K.) and the Departments of Transplant Surgery (N.E.) and Pathology (R.L.K.), Massachusetts General Hospital, Boston; New England Organ Bank, Newton, MA (F.L.D.); and the Departments of Medicine (C.N.K.) and Surgery (N.E., F.L.D.), Harvard Medical School, Boston.

NEJM, Volume 361:724-725 August 13, 2009 Number 7 - "Case 15-2009: A Man with Coma after Cardiac Arrest"

"To the Editor: Kotton et al. (May 14 issue) (...) present the case of a 25-year-old man with cardiac arrest. The initial rhythm was ventricular fibrillation. Despite successful resuscitation, brain death was declared and the heart was procured for transplantation. Although no structural abnormalities were identified on echocardiography or cardiac catheterization, primary ventricular fibrillation has many causes that are not readily diagnosed, (...) and when idiopathic it has a high rate of recurrence. (...) Therefore, the suitability of the donor's heart for transplantation needs to be determined by means of a thorough anatomical and electrophysiological assessment, which may be difficult to perform(...)"

Ventricular fibrillation : a condition that could make the donated heart unsuitable for transplantation needs ... And yet such hearts are procured and transplanted, putting the transplant patient at risk ...