We present the case of a 45-year-old patient who was brought to our emergency department with an out-of-hospital cardiac arrest. The patient arrived 45 minutes after collapse due to ventricular... Show moreWe present the case of a 45-year-old patient who was brought to our emergency department with an out-of-hospital cardiac arrest. The patient arrived 45 minutes after collapse due to ventricular fibrillation. The initial rhythm at arrival to the emergency department was asystole. His laboratory results showed profound lactic acidosis (lactate of 21 mmol/l and pH of 6.6). Time to arrival, rhythm at presentation and the observed lactic acidosis were all interpreted as prognostic signs of a poor outcome but, despite that, it was decided to treat the patient with extracorporeal cardiopulmonary resuscitation (ECPR). Subsequently percutaneous coronary intervention was performed. In contrast to the poor prognosis, the patient was discharged on day 6 with no discernible neurological deficit. This case illustrates that despite biochemical data suggesting profound tissue ischaemia/hypoxia, the outcome of ECPR may be excellent. Such data cannot be reliably used as a single indicator to decide whether or not ECPR should be initiated. Show less
This thesis gives insight into the patient group that survived an OHCA and gives directions to the development, evaluation and implementation of integrated rehabilitation treated programs, with the... Show moreThis thesis gives insight into the patient group that survived an OHCA and gives directions to the development, evaluation and implementation of integrated rehabilitation treated programs, with the ultimated goal being that all surviors and their spouses regain optimal quality of life and autonomy. Our studies showed that survivors of an OHCA attending a rehabilitation program may experience cognitive problems. A first attempt of identifying cognitive problems with a set of cognitive screening instruments in patients who attend a (cardiac) rehabilitation program appeared to be feasible, although the screening needs further refinement. The finding that cognitive impairments have a negative effect on exercise capacity is important to take into account while further optimising the best rehabilitation program. Finally, the rehabilitation program should not only focus on the patient but also on the spouse or the caregiver. By developing a core outcome set for rehabilitation the effectivenss of cognitive rehabilitation in OHCA patients and their relatives can be better evaluated. Show less
Schwarzl, M.; Steendijk, P.; Huber, S.; Truschnig-Wilders, M.; Obermayer-Pietsch, B.; Maechler, H.; ... ; Post, H. 2011
