A Successful Resuscitation of a Young Patient with Persistent Life Threatening Ventricular Fibrillation during a Minor Surgical Procedure

Aims: A discussion about the treatment options for cardiac arrest due to cocaine toxicity.
Presentation of Case: This is a case report of a young man who underwent general anesthesia for a urologic procedure. He suffered a ventricular fibrillation arrest and required over an hour of Advanced Cardiac Life Support (ACLS). Team Strategies & Tools to Enhance Performance and Patient Safety (TeamSTEPPS) techniques were utilized. Within one hour from the initiation of the dysrhythmia he received femoral vessel cannulation in preparation for extracorporeal membrane oxygenation (ECMO). The hypothermia protocol was instituted early for brain protection. The patient completely recovered with no neurological or cardiovascular sequelae from this life threatening cardiac arrest. Upon further investigation, it was discovered that cocaine was consumed one day prior to surgery.
Discussion: The use of cocaine is associated with multiple cardiovascular complications including ventricular fibrillation which was the probable etiology of this patient’s dysrhythmia. Recent studies elicited that there are underlying anatomic substrate alterations and changes in the molecular structure when cocaine is used. Cocaine stabilizes membranes in the nervous and myocardial tissue by antagonizing sodium and potassium channels. Multiple interventions were utilized which resulted in a successful resuscitation.
Conclusion: The implementation of ACLS, ECMO, hypothermic brain protection and team training all aided in the complete neurologic recovery in this patient.