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Cardiopulmonary resuscitation (CPR) must be interrupted for reliable rhythm analysis in current automatic external defibrillators because of artifacts produced by chest compressions. However, interruptions in CPR adversely affect the restoration of spontaneous circulation and survival. Suppressing CPR artifacts by digital signal processing techniques is a promising method to enable rhythm analysis during chest compressions, which would eliminate CPR interruptions for rhythm analysis. Although numerous methods have been developed to suppress CPR artifacts, the accuracy of rhythm analysis is still inadequate due to the residual artifact components in the filtered signal. This study proposes an enhanced adaptive filtering method to suppress CPR artifacts. A total of 183 shockable and 453 nonshockable segments of ECG signal, together with CPR-related reference signal, were extracted from 233 out of hospital cardiac arrest patients. The method was optimized on a training set with 85 shockable and 211 nonshockable segments, and evaluated on a testing set with 98 shockable and 242 nonshockable segments. Compared with artifact corrupted ECG signals, the signal-to-noise ratio (SNR) increased from −9.8 ± 12.5 to 11.2 ± 11.8 dB, and the accuracy was improved from 74.1% to 92.0% after filtering with the proposed method. Compared with the traditional adaptive filter, the SNR was improved by 1.7 dB and the accuracy was improved by 5.6 points. These results indicated that the proposed method could effectively suppress the chest compression related artifacts and improve the accuracy of rhythm analysis during uninterrupted CPR. [ABSTRACT FROM AUTHOR]

Aim: To provide therapeutic hypothermia (TH) to survivors after out-of-hospital cardiac arrest (OHCA), inter-hospital transfers (IHT) are frequently required. The safety of IHT remains controversial. The aim of this study was to investigate whether the effect of TH on brain recovery after OHCA differs between IHT and direct arrival groups.Methods: We identified patients with OHCA of presumed cardiac aetiology who were resuscitated by emergency medical services and experienced return-of-spontaneous circulation in 27 hospitals between January and December 2014. The main exposure variables were TH and IHT. The primary endpoint was discharge with good neurological recovery. We compared outcomes between the TH and non-TH groups using multivariable logistic regression with an interaction term between TH and IHT, after adjusting for potential confounders.Results: Among 1616 patients, 576 patients were included in the final analyses. Neurologic recovery was better in the TH group (46.2%) than in the non-TH group (20.1%) (adjusted odds ratio [aOR] 2.03 [95% confidence interval (CI) 1.24-3.33]). In the interaction model for the outcome of good neurological recovery, the aOR for TH was 2.82 (95% CI 1.59-5.01) in the direct transfer group vs. 0.76 (95% CI 0.29-2.01) in the IHT group. The measure of interaction on the multiplicative scale in this model was also statistically significant (OR 0.27 [95% CI 0.07-0.83]; p=0.02).Conclusion: IHT modified the effect of TH on neurological recovery for survivors of OHCA. TH is significantly less beneficial for good neurological recovery in patients who arrive via IHT than for those who arrive directly. [ABSTRACT FROM AUTHOR]

Objectives: To characterize intensivist handoff practices and expectations and to explore perceptions of the patient safety implications of attending handoffs.Design: Cross-sectional electronic survey administered in 2014.Setting: One hundred sixty-nine U.S. hospitals with critical care training programs accredited by the Accreditation Council for Graduate Medical Education.Subjects: Academic intensivists were recruited via e-mail invitation from a database of 1,712 eligible academic intensivists.Interventions: None.Measurements and Main Results: Six hundred sixty-one intensivists completed the survey (completion rate, 38.6%). Responses were received from at least one individual at 147 of 169 unique hospitals (87.0%) represented in the study database. Five hundred seventy-three (87%) respondents reported participating in handoffs at the end of each ICU rotation. A variety of communication methods were used for end-of-rotation handoffs, including in-person discussion (92.9%), telephone calls (83.9%), e-mail messages (69.0%), computer-generated documents (64.6%), and text messages (23.6%). Mean satisfaction with current handoff process was rated as 68.4 on a scale from 0 to 100 (SD, 22.6). Respondents (55.4%) said that attending handoffs should be standardized, but only 13.3% (76/572) of those participating in end-of-rotation handoffs reported using a standardized process. Specific handoff topics, including active clinical issues and resuscitation status, were reportedly discussed less frequently than would be ideal (p < 0.001 for the difference between reported frequency and ideal frequency). In free-text comments, 76 respondents (11.5%) expressed skepticism that attending handoffs were necessary given the presence of residents and fellows and given a lack of agreement about necessary content. Two hundred respondents (30.8%) reported knowing of an adverse event (inappropriate treatment, cardiac arrest, and death) attributable to inadequate attending handoffs.Conclusions: ICU attending handoffs in the United States exhibit marked heterogeneity, and intensivists do not agree about the value of attending handoffs. In addition, some intensivists perceive a link between suboptimal attending handoffs, inappropriate treatment, and serious adverse events that warrants further study. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to assess whether there was a significant difference in the complications of cardiopulmonary resuscitation (CPR) between out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA) survivors using multidetector computed tomography (MDCT). Subjects and Methods: We performed a retrospective analysis of prospective registry data. We enrolled both OHCA and IHCA patients who underwent successful CPR. We classified chest injuries secondary to chest compression into rib fractures, sternum fractures, and uncommon complications such as lung contusions and extrathoracic complications. We compared these complications according to CPR locations. We also analysed risk factors for CPR complications using multiple regression analysis and classification and regression tree analysis. Results: During the study period, a total of 148 patients were included in the primary analysis. Rib fractures were detected more in OHCA survivors than in IHCA survivors (74 patients (83.2%) vs. 37 patients (62.7%), p=0.05), and frequency of multiple rib fractures was higher in OHCA survivors than IHCA survivors (69 patients (77.5%) vs. 34 patients (57.6%), p=0.01). Although other complications were not significantly different between the groups, there was a trend for OHCA survivors to sustain more serious and direct high-energy related complications. Older age, longer CPR, and OHCA were significantly associated with incidence of rib fractures, multiple rib fractures, and number of rib fractures. Conclusions: Rib fractures were more likely to occur in OHCA survivors, and serious complications tended to occur more often in OHCA compared to IHCA survivors. [ABSTRACT FROM AUTHOR]

The author presents tips to physicians on how to diagnose the exact time of the death of a patient or a person. Topics discussed include the question of exactly when a person is actually dead, premature burial and resuscitation. Other topics include legislation defining death, physical signs of death, and diagnosing death after at least two minutes of electrical asystole or mechanical asystole is confirmed.

In this article a concept of non-local consciousness will be described, based on recent scientific research on near-death experiences (NDEs). Since the publication ofseveral prospective studies on NDEs in survivors of cardiac arrest, with strikingly similar results and conclusions, the phenomenon of the NDE can no longer be scientifically ignored. In the last thirty years several theories have been proposed to explain an NDE. The challenge to find a common explanation for the cause and content of an NDE is complicated by the fact that an NDE can be experienced during various circumstances, such as severe injury of the brain as in cardiac arrest to conditions when the brain seems to function normally. The NDE is an authentic experience which cannot be simply reduced to imagination, fear of death, hallucination, psychosis, the use of drugs, or oxygen deficiency. Patients appear to be permanently changed by an NDE during a cardiac arrest of only some minutes duration. According to these aforementioned studies, the current materialistic view of the relationship between consciousness and the brain as held by most physicians, philosophers, and psychologists is too restricted for a proper understanding of this phenomenon. There are good reasons to assume that our consciousness does not always coincide with the functioning of our brain: enhanced or non-local consciousness can sometimes be experienced separately from the body. [ABSTRACT FROM AUTHOR]

Background: Optimal acceptable time intervals from collapse to bystander cardiopulmonary resuscitation (CPR) for neurologically favorable outcome among adults with witnessed out-of-hospital cardiopulmonary arrest (CPA) have been unclear. Our aim was to assess the optimal acceptable thresholds of the time intervals of CPR for neurologically favorable outcome and survival using a recursive partitioning model. Methods and Findings: From January 1, 2005 through December 31, 2009, we conducted a prospective population-based observational study across Japan involving consecutive out-of-hospital CPA patients (N = 69,648) who received a witnessed bystander CPR. Of 69,648 patients, 34,605 were assigned to the derivation data set and 35,043 to the validation data set. Time factors associated with better outcomes: the better outcomes were survival and neurologically favorable outcome at one month, defined as category one (good cerebral performance) or two (moderate cerebral disability) of the cerebral performance categories. Based on the recursive partitioning model from the derivation dataset (n = 34,605) to predict the neurologically favorable outcome at one month, 5 min threshold was the acceptable time interval from collapse to CPR initiation; 11 min from collapse to ambulance arrival; 18 min from collapse to return of spontaneous circulation (ROSC); and 19 min from collapse to hospital arrival. Among the validation dataset (n = 35,043), 209/2,292 (9.1%) in all patients with the acceptable time intervals and 1,388/2,706 (52.1%) in the subgroup with the acceptable time intervals and pre-hospital ROSC showed neurologically favorable outcome. Conclusions: Initiation of CPR should be within 5 min for obtaining neurologically favorable outcome among adults with witnessed out-of-hospital CPA. Patients with the acceptable time intervals of bystander CPR and pre-hospital ROSC within 18 min could have 50% chance of neurologically favorable outcome. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: Describe the epidemiology and the survival of patients with traumatic cardiac arrest (CA), and compare them to those with nontraumatic CA. Highlight the weaknesses in their care and consider ways to improve their survival. Method: Traumatic and nontraumatic CA are described using the Utstein style in the “réseau nord-alpin des urgences” registry. Regarding the traumatic CA, we focus on circumstances, types of injuries and specific resuscitation techniques used. Results: From 1st January 2004 to 31st December 2005, prehospital medical teams provided care to 1552 victims of CA, 129 of whom were trauma patients (8.3%). Average age was 47.1 years; 74.4% were males. Blunt trauma occurred in 94.6%. None of the patients had chest tube insertion or thoracotomy on the scene. A return of spontaneous circulation was observed in 24.8%, the survival after 24h was of 3.9%, and 0.8% of patients remained alive 1 year following the accident. The topography of lesions responsible for the CA as well as the fact that these lesions are limited or multiorgan influence the survival. Conclusion: The survival of patients with prehospital traumatic CA is catastrophic and it is worse than that of patients with nontraumatic CA. However, a specific earlier and more adapted prehospital resuscitation could help improve this survival. [Copyright &y& Elsevier]

Summary: Aim of the study: To evaluate quality of cardiopulmonary resuscitation (CPR) performed during transport after out-of-hospital cardiac arrest. Materials and methods: Retrospective, observational study of all non-traumatic cardiac arrest patients older than 18 years who received CPR both before and during transport between May 2003 and December 2006 from the community run EMS system in Oslo. Chest compressions and ventilations were detected from impedance changes in routinely collected ECG signals, and hands-off ratio calculated as time without chest compressions divided by total CPR time. Results: Seventy-five of 787 consecutive out-of-hospital cardiac arrest patients met the inclusion criteria. Quality data were available from 36 of 66 patients receiving manual CPR and 7 of 9 receiving mechanical CPR. CPR was performed for mean 21±11min before and 12±8min during transport. With manual CPR hands-off ratio increased from 0.19±0.09 on-scene to 0.27±0.15 (p =0.002) during transport. Compression and ventilation rates were unchanged causing a reduction in compressions per minute from 94±14min−1 to 82±19min−1 (p =0.001). Quality was significantly better with mechanical than manual CPR. Four patients (5%) survived to hospital discharge; two with manual CPR (Cerebral performance categories (CPC) 1 and 2), and two with mechanical CPR (CPC scores 3 and 4). No discharged patients had any spontaneous circulation during transport. Conclusions: The fraction of time without chest compressions increased during transport of out-of-hospital cardiac arrest patients. Every effort should therefore be made to stabilise patients on-scene before transport to hospital, but all transport with ongoing CPR is not futile. [Copyright &y& Elsevier]

Summary: Background: Undetected malpositioned or dislodged ventilation tubes during cardiac arrest have fatal consequences, and no single method can detect the tube position reliably during such low-flow states. We wanted to test the ability of impedance changes as measured across the chest via the standard defibrillation pads to distinguish between oesophageal and tracheal ventilations in non-circulated patients. Materials and methods: After the end of futile resuscitation transthoracic impedance was measured with a prototype defibrillator, and ventilation variables were collected with a spirometer-capnography unit during tracheal ventilations and after repositioning of the tube; during oesophageal ventilations for paired comparisons. Results: We registered 123 oesophageal and 178 tracheal ventilations in nine patients. Transthoracic impedance changes associated with ventilations were always larger during tracheal than oesophageal ventilations (mean difference 1.3Ω (95% CI 1.0, 1.5), P <0.001), and all such changes above 1.2Ω were associated with tracheal ventilations, while changes below 0.4Ω always were associated with oesophageal ventilations. By subtracting 0.5Ω from the individual mean transthoracic change associated with tracheal ventilations, tube position was predicted with sensitivity 0.99 and specificity 0.97. Conclusion: Transthoracic impedance changes may be used to detect malpositioned and dislodged tubes also during situations without spontaneous circulation. Our predictive values must be retested in another population. [Copyright &y& Elsevier]

We report the case of an 18-year-old female who presented as an out-of-hospital ventricular fibrillation cardiac arrest. She required ICD insertion and recovered without deficit. Following recurrent syncopal episodes we diagnosed the co-existence of Neurocardiogenic syncope. [ABSTRACT FROM AUTHOR]

Summary: Background: Good scientific evidence is scarce in relation to the effectiveness of different methods of teaching basic life support (BLS) to the general public. In order to test new courses or methods a reference course is needed as a comparative standard. Objective: To propose a reference BLS provider course that can be used as a comparator when testing new courses or teaching methods. Methods: All national resuscitation councils that are represented in the European Resuscitation Council (ERC) were sent a questionnaire about the BLS provider courses run by them or under their auspices. Results: Sixteen national resuscitation councils responded to the enquiry. Their responses regarding organisation, structure, content and methods of the courses were found to be remarkably consistent between European countries. Few issues had a high variance. Conclusions: Based on the responses received, a reference BLS provider course for lay persons is suggested as a tool for research. The course duration is 3h 15min (excluding breaks), with 2h 15min practice time for the participants, 30min for theory and 20min for practical demonstrations by the instructor. A manual is distributed at the start of the course. The ratio of instructors to participants is one to six. The lectures are interactive between the instructor and the participants. Cardiopulmonary resuscitation (CPR) is practised on manikins in groups of six. A formal BLS scenario test may be held at the end of the course as part of a research study or if the candidates so request. It is suggested that by using this reference course during research into lay person BLS teaching, it will be easier to make comparisons between different studies. [Copyright &y& Elsevier]

Cardiac arrest is defined as cessation of cardiac mechanical activity. Cardiopulmonary resuscitation (CPR) is an attempt to restore spontaneous circulation through several maneuvers and techniques. Although the two interventions, which are competent basic life support and prompt defibrillation, improve the survival rate, several adjuvant cardiac medication drugs are advocated to treat cardiac arrest during advanced cardiac life support. Since the introduction of modern CPR there have been many advances in the field of pharmacotherapy in CPR. Therefore, we aimed to summarise the cardiac medication drugs used for patients in ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) or non VF/VT in the practice of advanced cardiac life support. Towards achieving this aim, the effects and practical issues related to vasopressors, antiarrythmic agents and, others such as sodium bicarbonate, calcium, magnesium and atropine will be addressed in the scope of the recent updates in the literature. [ABSTRACT FROM AUTHOR]

Abstract: Objective:: LUCAS is a new device for mechanical compression and decompression of the chest during cardiopulmonary resuscitation (CPR). The aim of this study was to compare the efficacy of this new device with standard manual external chest compressions using cerebral cortical blood flow, cerebral oxygen extraction, and end-tidal CO2 for indirect measurement of cardiac output. Drug therapy, with adrenaline (epinephrine) was eliminated in order to evaluate the effects of chest compressions alone. Methods:: Ventricular fibrillation (VF) was induced in 14 anaesthetized pigs. After 8min non-intervention interval, the animals were randomized into two groups. One group received external chest compressions using a new mechanical device, LUCAS. The other group received standard manual external chest compressions. The compression rate was 100min−1 and mechanical ventilation was resumed with 100% oxygen during CPR in both groups. No adrenaline was given. After 15min of CPR, external defibrillatory shocks were applied to achieve restoration of spontaneous circulation (ROSC). Cortical cerebral blood flow was measured continuously using Laser-Doppler flowmetry. End-tidal CO2 was measured using mainstream capnography. Results:: During CPR, the cortical cerebral blood flow was significantly higher in the group treated with LUCAS (p =0.041). There was no difference in oxygen extraction between the groups. End-tidal CO2, an indirect measurement of the achieved cardiac output during CPR, was significantly higher in the group treated with the LUCAS device (p =0.009). Restoration of spontaneous circulation was achieved in two animals, one from each group. Conclusions:: Chest compressions with the LUCAS device during experimental cardiopulmonary resuscitation resulted in higher cerebral blood flow and cardiac output than standard manual external chest compressions. These results strongly support prospective randomised studies in patients to evaluate this new device. [Copyright &y& Elsevier]

Abstract: Aim: : To investigate the level of cardiopulmonary resuscitation (CPR) training among cardiac patients and their co-habitants and to describe the possibilities for, and obstacles to, CPR training among this group. Methods: : All patients admitted to a coronary care unit during a four-month period were considered for participation in an interview study. Out of 401 patients, 268 were co-habiting. This study deals with these subjects. Results: : According to the answers given by the patients, 46% of the patients and 33% of the co-habitants had attended a CPR course at some time. Among those who had not previously attended a course, 58% were willing to attend, and 60% of the patients whose co-habitant had not received CPR education, wanted him or her to attend a course. The major obstacle to CPR training was the patient''s own medical status. The major obstacle to the co-habitant''s participation was the patient''s doubts concerning their partner''s physical ability or willingness to participate. Younger persons were more often willing to undergo training than older persons (p &#60;0.0001). Of those patients who had previously attended a course or who were willing to undergo training, 72% were prepared to do so together with their co-habitant. A course specially designed for cardiac patients and their relatives was a possible alternative for 75% of those willing to participate together with their co-habitant. Conclusions: : Two-thirds of the patients did not believe that their co-habitant had taken part in CPR training. More than half of these would like their co-habitant to attend such a course. Seventy-two percent were willing to participate in CPR instruction together with their co-habitant. Major obstacles to CPR training were doubts concerning the co-habitant''s willingness or physical ability and their own medical status. [Copyright &y& Elsevier]

Abstract: There is a lack of high-quality information about the effectiveness of resuscitation interventions and international differences in structure, process and outcome after out-of-hospital cardiac arrest and cardiopulmonary resuscitation because data are not collected uniformly. An internet-based international registry could make such evaluations possible, and enable the conduct of large randomized controlled trials of resuscitation therapies. A prospective international cohort study was performed that included 571 infants, children and adults (a) who experienced cardiac arrest requiring chest compressions or external defibrillation, (b) outside the hospital in the study communities and (c) upon whom resuscitation was attempted by EMS personnel. Cardiac arrest was defined as lack of responsiveness, breathing or movement in individuals for whom the EMS system is activated for whom an arrest record is completed. All data were collated via a secure and confidential web-based method by using automated forms processing software with appropriate variable range checks, logic checks and skip rules. Median number of missing responses for each variable was 0 (interquartile range 0, 0). Twenty-seven percent of the patients had a first recorded rhythm of ventricular fibrillation or ventricular tachycardia, 60% had a witnessed arrest, and 34% received bystander CPR. Mean time from call to arrival on scene was 7.1±5.1min. Six percent of the patients survived to hospital discharge. The resuscitation process was highly variable across centers, and survival and neurological outcome were also significantly and independently different across centers. This study shows that it is possible to collect data prospectively describing the structure, process and outcome associated with cardiac arrest in multiple international sites via the internet. Therefore, it is feasible to conduct adequately powered randomized trials of resuscitation therapies in international settings. [Copyright &y& Elsevier]

Purpose: To evaluate whether cerebral CT findings taken immediately after successful resuscitation from cardiopulmonary arrest (CPA) correlate with the outcome or not.Material and Methods: We analyzed retrospectively brain sections with the Housfield unit (CT number). Between May 2001 and March 2004, 16 consecutive patients, who recovered from CPA, were included as subjects in this study. They satisfied all of the following criteria: (a) a helical multislice head CT was performed within 1 h of the return of the spontaneous circulation (ROSC); (b) patients died within 24 h after ROSC, and any patients with trauma or cerebral vascular disease were excluded. The subjects were divided into two groups; those with a cerebral performance category of 1-3 (GR group) and those with a cerebral performance category of 4-5 (VD group).Results: There were no significant differences between the two groups except for age. The average ventricle size on the brain CT showed no significant difference between the two groups. The average CT number of the putamen and cerebral cortex, and the corticomedullary contrast in the GR group were higher than those in the VD group.Conclusion: Although the influence of age cannot be disregarded, the CT number of the putamen and cortex, and also the corticomedullary contrast correlated with outcome of hypoxic encephalopathy even when cerebral CT was performed within 1 h after ROSC following CPA. [ABSTRACT FROM AUTHOR]

Abstract: Introduction:: Although modern defibrillators are nearly always successful in terminating ventricular fibrillation (VF), multiple defibrillation attempts are usually required to achieve return of spontaneous circulation (ROSC). This is potentially deleterious as cardiopulmonary resuscitation (CPR) must be discontinued during each defibrillation attempt which causes deterioration in the heart muscle and reduces the chance of ROSC from later defibrillation attempts. In this work defibrillation outcomes are predicted prior to electrical shocks using a neural network model to analyse VF time series in an attempt to avoid defibrillation attempts that do not result in ROSC. Methods:: The 198 pre-shock VF ECG episodes from 83 cardiac arrest patients with defibrillation conversions to different outcomes were selected from the Oslo ambulance service database. A probabilistic neural network model was designed for training and testing with a cross validation method being used for the better generalisation performance. Results:: We achieved an accuracy of 75% in overall prediction with a sensitivity of 84% and a specificity of 65% using VF ECG time series of an order of 1s in length. Conclusion:: Pre-shock VF ECG time series can be classified according to the defibrillation conversion to a return of spontaneous circulation (ROSC) or No-ROSC. [Copyright &y& Elsevier]

Provides general information resuscitation. Main components; Key steps of management; Need to develop standardized, evidence-based practice and to establish systems for staff training and practice; Basic life support; Advanced life support; Organization and training.

Secondary analysis is a resourceful approach for making further use of existing data sets to answer questions not previously addressed or to expand on content not specifically examined in the original study. Using Heideggerian hermeneutics, the author analyzed transcripts of the stories of individuals with implantable cardioverter defibrillators (ICD) from three of her earlier phenomenological studies to obtain a description of the experience of living with an ICD after a sudden cardiac death experience. Three elated themes emerged: (a) losing control: technology as lifesaving yet changing everything; (b) getting on with living: regaining control or conditional acceptance; and (c) creating a new vision: transformation or tenuous truce. The constitutive pattern was redefining life while forestalling death. [ABSTRACT FROM AUTHOR]

The article discusses research on autoresuscitation during the process of organ recovery from donors after cardiac death. It references the study of Sheth and colleagues in the same issue regarding the University of Maryland Shock Trauma Center's observations on the required waiting period before organ procurement begins. It says that any incident of autoresuscitation was not observed two minutes after the cessation of a patient's cardiopulmonary function.

Abstract: Tako-Tsubo Cardiomyopathy (TTC) is described as transient left ventricular (LV) dysfunction without coronary artery stenoses. Typically the onset of TTC-syndrome is following emotional or physical stress. As an acute cardiac syndrome it is mimicking ST-elevation myocardial infarction. In this case we report from a 73-year old woman presenting with cardiac arrest after a long-distance bus-tour, and ongoing resuscitation to our ICU. Advanced life support with temporary ventricular pacing was continued until onset of stable spontaneous circulation. Left ventricular angiography revealed normal coronary arteries and the typical apical ballooning phenomenon. Echocardiographic findings resolved completely within 10 days. The patient survived, achieved good cerebral recovery (CPC 1) and was alert and fully oriented on discharge after 18 days. [Copyright &y& Elsevier]

Abstract: The international medical literature described sporadical cases of an exceptional event called the “Lazarus phoenomenon”. This is the spontaneous reviviscence of an individual after a long time of asystolia following a cardiac accident depending on different pathogenesis (i.e. aritmia, ischaemic stroke, haemorrhage, brainstem death). All of the reported cases concerned patients presenting recovery after discontinuation of cardiopulmonary resuscitation. Different explanations of the phisiopathology of the phoenomenon can be given, first of all, the latency of catecholamine action in such patients. We report the case of an 81-year-old woman who experienced a cardiac accident on the street. Once the cardiopulmonary resuscitation was interrupted, the patient presented life activities after some minutes. [Copyright &y& Elsevier]