42-year-old male found down in a hotel lobby.  PMH is unknown.  EMS reports patient was initially pulseless and severely bradycardic.  He transiently would have ROSC with ACLS.  Upon arrival to the ED, he once again became pulseless and ACLS was initiated.  EMS reports they had been "working on the patient" for over 20 minutes and he was without a pulse for "most of it."  Three minutes into the resuscitation the patient has ROSC and you quickly perform a bedside echo...

Take the Challenge