Hemodynamics of cough cardiopulmonary resuscitation in a patient with sustained torsades de pointes/ventricular flutter.

A 43-year-old female with old myocardial infarction and stenosed bypass grafts developed sustained Torsades de Pointes/ventricular flutter (rate = 300-400 beats per minute) during coronary arteriography after contrast injection to the diagonal graft. Cough-CPR (rate = 37/min) was started within 5 s of dysrhythmia initiation and continued through two defibrillation attempts (200 and 360 joules), and IV lidocaine was administered until return of spontaneous circulation 62 s later. The patient never lost consciousness during this very rapid dysrhythmia. Certain cardiac arrest resuscitation measures (namely, initial defibrillation attemps, IV lidocaine administration) can thus be initiated in a patient while performing cough-CPR and maintaining adequate cerebral perfusion. During the dysrhythmia with Cough-CPR: (a) aortic systolic pressures averaged 100 mmHg--this has commonly been observed in other reports, and (b) aortic diastolic pressures were always > or = 50 mmHg and averaged 63 mmHg, which has seldom been this high during cough-CPR. Dysrhythmia reversion occurred 4 s after the second defibrillation attempt and 80 msec after the peak of the highest cough-generated aortic pressure pulse (128 mmHg). Cough-induced ventricular tachycardia reversion has previously been reported; this may have acted in concert with electrical defibrillation to facilitate dysrhythmia reversion. The patient recovered without incident.