CASE REPORT

Paramedics were called to a collapsed 75 year old man. They found him in cardiac arrest. Cardiac monitoring demonstrated pulseless electrical activity (PEA) with regular pacing spikes. They identified a device inserted in the left pectoral region. An endotracheal tube was passed and cardiopulmonary resuscitation (CPR) was started. Adrenaline (epinephrine) and atropine were administered. External pacing was started and a palpable pulse was established before transfer to hospital.

On arrival at hospital the cardiac output was lost. With the external pacing turned off, the patient was in asystole with the occasional pacing spike. CPR was restarted. After a few minutes the patient was witnessed to jolt during cardiac massage, this recurred a few minutes later. After the second episode it was suspected that the patient was fitted with an ICD and not a pacemaker. This was confirmed when literature on the device was produced by the …