Viva 5

A 45 year-old man post-attempted hanging was found 4 days ago by his family in cardiac arrest. His initial rhythm was asystole. He received 45 minutes of cardiopulmonary resuscitation before return of spontaneous circulation.

Past history includes previous suicide attempts, moderate alcohol intake, hypertension and multiple skin cancer excisions.
At present his pupils are fixed and dilated and corneal reflex is absent. He is breathing spontaneously and has a cough reflex.

He initially had myoclonus but now only extends to pain. He has not had any sedation for 72 hours. He is on 0.2mcg/Kg/min noradrenaline for BP support and does not have any other overt organ failure.


His CT scan done 24 hours earlier shows loss of grey-white matter differentiation and bilateral thalamic infarcts.


Can you outline the important information about this man’s cardiac arrest and why?

Disclaimer: the viva stem above may be an original CICM stem, acquired from their publicly available past papers. Or, perhaps it is a slightly altered version of the original CICM stem. Or, it is a completely original viva stem, concocted by the monstrously amoral author of Deranged Physiology for nothing more than his own personal amusement. In either case, because the college do not make the main viva text or marking criteria available, almost everything here has been confabulated. It might sound like a plausible viva and it could be used for the purpose of practice, but all should be aware that it does not represent the "true" canonical CICM viva station.