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Emerg Med J 2006;23:e20 doi:10.1136/emj.2005.030114
  • Emergency casebook

Lower limb amputation with CPR in progress: recovery following prolonged cardiac arrest

  1. R Wise1,
  2. I Higginson2,
  3. J Benger2,
  4. N Rawlinson1
  1. 1Emergency Department, United Bristol Healthcare Trust, Bristol, UK
  2. 2Academic Department of Emergency Care, Emergency Department, United Bristol Healthcare Trust, Bristol, UK
  1. Correspondence to:
 Dr J Benger
 Academic Department of Emergency Care, Emergency Department, United Bristol Healthcare Trust, Bristol BS2 8HW, UK; jonathan.benger{at}ubht.nhs.uk
  • Accepted 28 September 2005

Abstract

Intravenous drug users (IVDUs) often present to the emergency services with the medical complications of drug use. We report a case in which an acutely ischaemic lower limb of one such patient was thought to be the cause of cardiac arrest occurring during treatment in the emergency department (ED). Amputation of the limb was performed with cardiopulmonary resuscitation (CPR) in progress, spontaneous cardiac output was restored, and the patient made an excellent neurological recovery despite a total arrest time of 85 minutes. Possible causes of cardiac arrest, in relation to the release of potassium and metabolic toxins are discussed, as well as the decision making processes of the involved clinicians and other possible management strategies.

Footnotes

  • Competing interests: none declared

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