Hello, this is my 1st post here (it's going to be a long post) and English is not my 1st language; sorry in advance for any grammar or vocabulary errors. I've already posted this on r/ems and I've been told it might be appreciated here.
This is one of the longest cardiac arrest episodes ever reported, on par only with another episode of deep accidental hypothermia 8 hours 40 minutes long in 2014. Here's the PubMed link: https://www.ncbi.nlm.nih.gov/pubmed/30420231 but I'm going to translate and adapt in English a short Italian article that appeared recently.
Fact happened in the Dolomite Mountains (province of Belluno, in Northern Italy) back in 2017.
Premise: the HEMS base of Pieve di Cadore (in the middle of the Dolomites) uses a H145 helicopter (callsign Falco, "Hawk") with a crew of 5 – pilot; HEMS crewmember/hoist operator; rescuer of the "Soccorso Alpino" (Alpine and Speleological Rescue National Corp); anaesthesiologist; flight nurse. The helicopter was and still is operational only during daytime (and in the near future it will begin H24 activity with NVG).
Now to the story.
It's August 2017. Roberto (31 years old) and his friend Alessandro are two experienced mountain climbers; they are climbing the south face of mount Marmolada (3'343 m / 11'000 ft, the highest peak in the Dolomites) and it's a clear, sunny summer day. However, in the afternoon, weather conditions deteriorate rapidly: at 16:40, at an altitude of 2'400 m / 7'900 ft, the two are hit by a sudden thunderstorm with hail. Alessandro manages to find (relative) shelter, but Roberto is not so lucky and finds himself unable to move under a waterfall of freezing water and ice.
As Roberto doesn’t answer him, Alessandro climbs up to his position and finds him unconscious and in deep hypothermia. He immediately tries to call for rescue but there is no phone coverage, so he resorts to use his flashlight to make signals towards the valley. Some 800 mt lower, the owner of the rifugio (alpine hut, lodge) “Falier” spots the signals and contacts the rescue services; it’s 19:00.
The H145 helicopter of the Pieve di Cadore HEMS base is dispatched and manages to locate the climbers at 19:42. Sun is about to set and time available is very limited: the patient is recovered by the alpine rescuer via a 30-metre long hoist cycle and the helicopter lands immediately at the feet of the mountain, enabling the medical crew to begin advanced life support measures.
A low-voltage VF is observed; after a manual CPR cycle and a 200 J discharge, the automatic chest-compression system (LUCAS 3) is positioned followed by the endo-tracheal tube.
Despite the efforts, at 20:10 the patient reaches Pulseless Electrical Activity and asystole. Measured core temperature is 26 °C (78.8 °F): Roberto is now in hypothermia-induced cardiac arrest.
At 20:20 the helicopter takes off towards the provincial spoke hospital of Belluno, as it is now too late to reach the regional hub hospital of Treviso (some 50 km / 32 miles further south of Belluno). The helicopter lands at Belluno at 21:00. The patient is quickly transferred to Treviso with an ambulance, reaching the hospital at 23:00; the LUCAS remains in action through the whole voyage.
Extra-Corporeal Membrane Oxygenation (ECMO) begins at 23:30 and it is decided to implement a gradual warming protocol of 1 °C/hour.
At 04:30, with a 32 °C core temperature measured, conversion from asystole to VF is observed: a 200 J discharge is immediately applied restoring a sinusoidal heart rate pattern.
Roberto has been in cardiac arrest for more than 8 hours; 3 hours 42 minutes long mechanical CPR followed by 5 hours long extra-corporeal life support was performed on him.
When he wakes up neurological signs are promising, with response of all 4 limbs.
ECMO is suspended the 10th day.
Life support is suspended the 21st day.
Aside from an episode of retrograde amnesia the 28th day, there are no other consequences: Roberto leaves the hospital fully recovered after 3 months and 10 days of rehab.
In case of hypothermia, “nobody is dead until warm and dead”.
A promotional video of LUCAS 3 about the fact:
Source: Original link
