Keeping Cool after Cardiac Arrest and Successful CPR 

May 31
2012

While enjoying some homemade stuffed pepper soup for supper on March 19th, 67-year old Laura “Delores” Duffey of Merrillville had a strange feeling in her chest.

“It was just a funny feeling, something a little bit different,” she said. “I told my husband Dannie that I thought I needed to go to the hospital. I just grabbed my insurance card, and we left. We didn’t even think about an ambulance. On the way, I couldn’t get my breath so my husband put on the air conditioning, and that’s about the last thing I remember.”

Cardiac arrest is a serious medical condition. During cardiac arrest the heart stops beating effectively and is unable to pump blood to the organs of the body. It usually occurs suddenly and unexpectedly. Death can occur within minutes unless treatment is started.

According to the American Heart Association, the vast majority of the 300,000 Americans who suffer cardiac arrest every year die. Despite massive investments in research and technology, fewer than 8 in 100 leave the hospital alive, a rate that has remained stagnant for almost 30 years. Even if the heart is restarted, only a minority make it - and of those who do, many end up in nursing homes with crippling brain injury, never able to live a normal life again.

Fortunately for the Duffeys, traffic was light at the time and upon arrival at the Methodist Hospital’s Southlake Emergency Department entrance, the rapid response team was able to start cardiopulmonary resuscitation (CPR) right in the parking lot.

“This demonstrates the importance of CPR training, at least chest compressions, for someone who is no longer breathing and their heart has stopped,” Dr. Ruby Long, an emergency physician and quality assurance director for emergency medicine at Methodist Hospitals said. “CPR starts the heart pumping, circulating good blood flow.”

“When we got out there she had no heart rate and was not breathing,” Jessica Wilson, RN, MSN, CNS explained. “As the resuscitation efforts continued, she was transported inside. Within 10 minutes she was brought back to spontaneous circulation.”

From there, the team began post-resuscitative care measures which now include therapeutic hypothermia at both Methodist campuses for patients who meet the criteria.

“At Methodist our doors are always open to the entire community, so it’s important for us to keep up with the most advanced education and training in order to implement the most up-to-date scientific guidelines,” Dr. Long, who has been trained in Advanced Therapeutic Life Support (ATLS) by the University of Pennsylvania’s Department of Emergency Medicine Center for Resuscitation Science, the gold standard when it comes to research and training that will save the lives of people who suffer cardiac arrest and shock, said.

“The decision to provide therapeutic hypothermia for near death experiences in the Emergency Department, ICU and Cardiac Cath Labs of Methodist Hospitals was a collaborative process and about a year in the making. On March 15th we went live for the whole hospital system, and to my knowledge, we are the only local facility treating patients with therapeutic hypothermia.”

“In this particular case, the most significant factor was the quick response, her down time was very minimal,” Wilson added. “Essentially, the patient is a healthy, independent 67-year old female who didn’t have any contra indications per our protocol.”

Basically a cooling treatment, therapeutic hypothermia improves survival and functional outcomes for one in six comatose survivors of cardiac arrest, according to University of Pennsylvania research. Methodist Hospital’s results are even better.

“We’ve had 8 people through the process successfully,” Dr. Long said. “The most notable improvement is that the majority survive, and they survive neurologically returning back to their homes and work.”

“Methodist has made a commitment to providing the very best in programs, technology and facilities to the people of northwest Indiana, especially in trauma and critical care,” Methodist Hospital’s president and CEO Ian McFadden said. “We employ a staff of skilled and experienced emergency physicians, nurses, technicians and support staff who provide emergency care 24- hour-a-day, 7 days-a-week. It is critical that we provide a workplace that lives up to the same high standard as our team in order to be the best place for patients to receive care.”

Endorsed by the American Heart Association, therapeutic hypothermia is performed by lowering the body temperature to 32°-34°C (approximately 90°-93°F) Normal body temperature is 37°C or 98.6°F. It works by protecting the brain and other vital organs. It lowers oxygen requirements, decreases swelling and limits the release of toxins which can cause cells to die.

“The therapy lasts for approximately 24 hours,” Wilson explained. “Then the patient is re-warmed very slowly, over about 12-18 hours until the body temperature returns to normal. Recovery occurs on an individual basis with some patients waking up quickly and others taking as long as 72 hours after re-warming is complete to begin waking up.”

Since it was determined that her cardiac arrest was brought on by a massive heart attack, Delores Duffey needed open heart surgery within 24 hours of re-warming. Even so, she was showing positive results within the 72-hour window, according to Wilson.

“Therapeutic Hypothermia protected Mrs. Duffey's brain and other vital organs,” her cardiovascular surgeon Dr. Ray Sawaqued said. “She was able to wake with a clear mind and return to a normal functional life.”

“When they started bringing me around, I had a tube in my throat so when the people in my family started coming one-by-one, asking if I recognized them, I would just nod,” Delores said. “I recognized everyone except my own sister. She lives in Ohio so I don’t see her very often, and she had recently gone from a red head to a blonde. I’m still not used to it.”

“She was a typical post cardiac surgical patient, well within the normal recovery,” Wilson added. “She was definitely ready to go home even before cardiac rehab started.”

“I was getting bored and ready to move on to something else,” Delores said. “When I finally came home a month later, climbing the stairs to get into the house was my first thing to conquer. I’ve been doing pretty well. I’m starting to get back in the kitchen and doing some cooking, that’s probably my favorite thing to do. I’m also doing some hand crafts and knitting. I still kind of tire easily, don’t have all my strength yet, but as everybody says, baby steps are normal after this type of surgery. Several people on my husbands’ side of the family and one of my girlfriends have all had open heart surgery. There’s were scheduled, mine was a big surprise.”

“Patients survive cardiac arrest everyday,” Dr. Long said. “But, to preserve their neurological function so they can go back to their families instead of a nursing home, that’s the benefit of therapeutic hypothermia. This is the type of state-of-the-art, evidence-based care that I realized along the way I could bring back to the community where I grew up. I’m from Gary, and I wanted to do something positive for my community.”

The Duffeys couldn’t agree more.

“As I was coming to, Dannie asked me if I wanted a special gift when we celebrate our 44th wedding anniversary in July,” Delores said. “I love jewelry so I pointed to my finger (indicating a new ring). He said that figures, and now I say I might change my mind by July, decide I want something different by then, but he just rolls his eyes when I say that.”

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