2. McNally B, Stokes A, Crouch A, et al. CARES: Cardiac arrest registry to
enhance survival. Ann Emerg Med. 2009; 54( 5):674–683.e2.
3. Neumar RW, Shuster M, Callaway CW, et al. Part 1: Executive summary: 2015 American Heart Association guidelines update for
cardiopulmonary resuscitation and emergency cardiovascular
care. Circulation. 2015;132( 18 Suppl 2):S315–S367.
4. Graham R, McCoy MA, Schultz AM, editors: Strategies to improve
cardiac arrest survival: A time to act. National Academies Press:
Washington, D.C., 2015.
5. Nichol G, Aufderheide TP, Eagle B, et al. Regional systems of care for
out-of-hospital cardiac arrest: A policy statement from the American Heart Association. Circulation. 2010;121( 5):709–729.
6. Georgiou M. Restart a Heart Day: A strategy by the European Resuscitation Council to raise cardiac arrest awareness. Resuscitation.
7. Daya MR, Schmicker RH, Zive DM, et al. Out-of-hospital cardiac arrest
survival improving over time: Results from the Resuscitation Outcomes Consortium (ROC). Resuscitation. 2015;91:108–115.
8. Malta Hansen C, Kragholm K, Pearson DA, et al. Association of
bystander and first-responder intervention with survival after out-of-hospital cardiac arrest in North Carolina, 2010–2013. JAMA.
9. Hasselqvist-Ax I, Riva G, Herlitz J, et al. Early cardiopulmonary
resuscitation in out-of-hospital cardiac arrest. N Engl J Med.
10. Nakahara S, Tomio J, Ichikawa M, et al. Association of bystander
interventions with neurologically intact survival among patients
with bystander-witnessed out-of-hospital cardiac arrest in Japan.
JAMA. 2015;314( 3):247–254.
11. Wissenberg M, Folke F, Hansen CM, et al. Survival after out-of-hospital cardiac arrest in relation to age and early identification
of patients with minimal chance of long-term survival.
Circulation. 2015;131( 18):1536–1545.
12. Chan PS, McNally B, Tang F, et al. Recent trends in survival from
out-of-hospital cardiac arrest in the United States. Circulation.
13. Bobrow BJ, Clark LL, Ewy GA, et al. Minimally interrupted cardiac
resuscitation by emergency medical services for out-of-hospital
cardiac arrest. JAMA. 2008;299( 10):1158–1165.
14. Lick CJ, Aufderheide TP, Niskanen RA, et al. Take Heart America: A
comprehensive, community-wide, systems-based approach to the
treatment of cardiac arrest. Crit Care Med. 2011; 39( 1): 26–33.
15. Hinchey PR, Myers JB, Lewis R, et al. Improved out-of-hospital cardiac arrest survival after the sequential implementation of 2005
AHA guidelines for compressions, ventilations, and induced
hypothermia: The Wake County experience. Ann Emerg Med.
2010; 56( 4):348–357.
16. Kurz MC, Wang HE. Improving post-arrest care through evidence-based common sense. Ann Emerg Med. 2014; 64( 5):507–508.
17. ECC Committee, Task Forces of the American Heart. 2005 American
Heart Association guidelines for cardiopulmonary resuscitation
and emergency cardiovascular care. Circulation. 2005;112( 24
18. Field JM, Hazinski MF, Sayre MR, et al. Part 1: Executive summary:
2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation.
2010;122( 18 Suppl 3):S640–S656.
19. Sporer K, Jacobs M, Derevin L, et al. Continuous quality improvement efforts increase survival with favorable neurologic outcome after out-of-hospital cardiac arrest. Prehosp Emerg Care.
2017; 21( 1): 1-6.
20. Stub D, Bernard S, Pellegrino V, et al. Refractory cardiac arrest
treated with Mechanical CPR, hypothermia, ECMO and early
reperfusion (the CHEER trial). Resuscitation. 2015;86:88–94.
21. Yannopoulos D, Bartos JA, Martin C, et al. Minnesota Resuscitation
Consortium’s Advanced perfusion and reperfusion cardiac life
support strategy for out-of-hospital refractory ventricular fibrillation. J Am Heart Assoc. 2016; 5( 6):e003732.
comprehension and social interaction. After
improving his strength and endurance from the
prescribed course of rehabilitation, he was discharged with no focal neurologic weakness other
than a slightly unsteady gait and was able to ambulate without assistive devices.
The total time from 9-1-1 call to UCSF transfer
was just a little over eight hours! The pieces of
this story not documented here are the personal
interactions and emotions of those involved with
the laborious care of this patient in the cardiac
One week following this case, a multidisciplinary
debriefing was conducted including leadership
from EMS, ED, catheterization lab, OR and ICU.
The insight from the debriefing dialogs made it
clear that leadership from the catheterization lab
facilitated multiple services within the hospital to
come together for the good of the patient.
Highland Hospital has the reputation of being on
the forefront of the most current and cutting-edge
medicine with its renowned residency programs.
In 2016, Highland had three patients go to the
cardiac catheterization lab for PCI with active resuscitation (i.e., mechanical CPR) that survived to
hospital discharge with good neurologic function. This further demonstrates their leadership
and commitment as a community champion to
improving patient outcomes.
Even though this case may be perceived as an
outlier and an exception to the rule, it strongly suggests that it does take a fearless scientific community working together on behalf of the patient to
achieve the unexpected. This case exhibits what we
may have found to be the next frontier in cardiac
arrest resuscitation, prolonged care with mechanical compressions and the application of ECMO. ✚
Michael J. Jacobs, EMT-P, is the manager for Alameda
County (Calif.) EMS Specialty Systems of Care, including
education and research related to cardiac arrest, STEMI,
stroke, trauma and CPR in schools. He’s also an EMS consultant for Coastside Fire Protection District in San Mateo
County and a clinical education consultant for Stanford
Karl A. Sporer, MD, FACEP, FACP, is the EMS medical
director for Alameda County and professor emeritus of
emergency medicine at the University of California, San
Francisco. He can be reached at firstname.lastname@example.org.
1. Sasson C, Rogers MA, Dahl J, et al. Predictors of survival rom out-of-hospital cardiac arrest: A systematic review and meta-analysis.
Circ Cardiovasc Qual Outcomes. 2010; 3( 1):63–81.