Always On EM - Mayo Clinic Emergency Medicine Grand Rounds - Dr Fiterman Molinari - Cardiac Arrest: when Standard Care is Not Enough
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May 14, 2025 Dr. Daniel Fiterman Molinari, a senior resident at Mayo Clinic and future leader in medical education, presents revolutionary ideas on cardiac arrest care. He urges a rethink of traditional resuscitation practices to enhance patient outcomes. With insights from case studies, he emphasizes personalized approaches and extends the discourse on innovative strategies like continuous chest compressions and advanced technologies. Listeners will find themselves reflecting on the literature and questioning established norms in emergency medicine.
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Challenging Prolonged Resuscitation Views
- A patient with prolonged cardiac arrest had multiple returns of spontaneous circulation yet died after repeated arrests.
- The clinical team struggled with cessation decisions due to outdated ACLS recommendations discouraging prolonged resuscitation.
Survival Possible Beyond 30 Minutes
- Studies show some patients survive cardiac arrest even after 30 minutes or more of resuscitation.
- Stopping resuscitation strictly at 30 minutes may deny survival chances to a meaningful subset of patients.
Neurologic Outcomes Aren't Worse
- Prolonged resuscitation survivors demonstrate neurological outcomes comparable to earlier survivors.
- The assumption that long resuscitation leads to poor neurologic function is inaccurate.