Tuesday, July 24, 2012

100 Minutes Dead Mother Saved With CPR

We have here further confirmation that CPR application induces enough blood mobility to prevent brain damage for extended periods of time. Recall last year, they used a CPR machine in a London hospital to keep a patient alive over two and one half hours. In this case, they have saved the patient with physically applied CPR under changing and difficult conditions. Today it is clear that first responders know that survival is possible provided that CPR is applied promptly and maintained.

As it turns out I personally survived twenty minutes without a heart beat and was also saved by prompt CPR some seven years ago. The produced data was unambiguous and I suspect it led then to an increase in awareness to the possibilities that is now culminating in serious efforts to save lives.

Recall that over ninety percent of heart attack victims outside a hospital do not survive because the heart stops and CPR is not applied promptly. Greater public awareness is now needed because it is clearly possibly to cut this figure in half at least as most such heart attacks are actually survivable.

In the meantime, this report demonstrates that even in difficult situations, CPR can be sustained.

B.C. mother survives sudden brush with death


The deadly virus could have come from virtually anywhere: her husband’s kiss, a shopping cart’s handle, the cough of a stranger. Slowly, it took hold in Chelsie Thurlow’s body, multiplying, spreading, slipping into her cells.

For two weeks, Thurlow, now 24, had suffered flu-like symptoms. The animal-care assistant at a veterinary hospital had a fever, severe body aches, a sore throat. Then her voice rose in pitch, leading Thurlow’s mother to tell her over the phone, “You sound really awful.”

Still, as a new mother, Thurlow was immersed in caring for her daughter Chloe, just four months old.

On Oct. 21, 2010, Thurlow put Chloe in a swing at their Richmond, B.C., home. Her husband, Stephan Bouchard, a renovations contractor, was at work.

Feeling so weak she could barely move, Thurlow thought she ought to eat, but when she opened the cupboard to grab peanut butter to spread on toast, the sight of the jar made her want to vomit. A fit woman who ate healthy food, Thurlow knew it was time to get medical help.

She had no idea that her particular physical makeup made her especially vulnerable to a not-uncommon condition called viral myocarditis. Caused by any of a hundred viruses, the disease can have unnoticeable effects in many people. Thurlow’s immune system sent virus-attacking white blood cells into her heart. But the enzymes released by her white cells to destroy invading pathogens were causing heavy collateral damage to the organ that pumps her blood.

Her doctor’s office said she couldn’t be seen until evening. Within an hour, Thurlow was too weak to lift her daughter. She called her husband. He asked if he should call for an ambulance. She asked him to come home and drive her to hospital.

I thought maybe she was a little bit tired with taking care of the baby,” Bouchard says.

He wrapped up his day’s job and was home 40 minutes later.

On the way to Richmond Hospital with Bouchard, and Chloe in a car seat, Thurlow noticed a tightness in her chest. She has asthma, so didn’t pay much attention to the new sensation. The feeling, however, was a symptom of myocarditis: her heart was inflamed, and enlarging. Ultimately it would swell to half-again its normal size.

At the emergency department’s triage desk, Thurlow explained that she was a new mom, and she just needed treatment so she could return home and care for her baby daughter. Doctors decided to take an ultrasound of her chest.

Bouchard told a doctor he wanted to go home and eat, then come back when Chelsie had been treated. “The doctor says, ‘You might want to stick around, because we don’t know,’” Bouchard remembers. Bouchard instead took Chloe up to the hospital cafeteria. Twenty minutes later, he heard the intercom broadcast a “Code Blue” in “diagnostic imaging.” On a previous hospital visit, Bouchard had asked a nurse what the various colour codes meant.

I know Code Blue is ‘cardiac arrest,’ and ‘diagnostic imaging’ sounds like ultrasound,” he says. But his wife was just sick with a cold, or the flu, or asthma, he thought, so the Code Blue must be for someone else. A minute later his name came over the intercom, calling him to emergency. A doctor, nurse and social worker were waiting for him.

There have been some complications with Chelsie,” the doctor told him. “She’s in cardiac arrest. We’ve been trying to revive her for 20 minutes, but we have not been successful.”

The doctor said Thurlow’s only hope was surgery at St. Paul’s Hospital in Vancouver, but she estimated Thurlow’s chance of survival at 10 per cent.

The world froze,” Bouchard says. “Twenty minutes ago, I’d just kissed my wife, who was nowhere near dying in my head.”

He asked to see his wife. A hulking doctor was above her, doing CPR.

It was not a pretty sight,” Bouchard says. “She had blood coming out of her mouth. Her eyes were kind of rolled back.

Bouchard pleaded with the doctors: “Please take her away now — hurry up, save her!”

Thurlow’s heart had stopped while doctors were watching it live via the ultrasound machine. A doctor had immediately started CPR.

The chest compressions went on for 35 minutes, to no avail. Typically, doctors, nurses and paramedics give up on a patient after 10 to 40 minutes of CPR. Attempts to jump-start her heart with a defibrillator failed. Thurlow was, effectively, dead. But she was young and healthy, and doctors kept up the CPR on the off-chance she could be saved.

Meanwhile, Richmond Hospital had contacted Dr. Anson Cheung, a pioneering cardiac surgeon at St. Paul’s Hospital in Vancouver. By the time Cheung received the call, Thurlow had been receiving CPR for 35 minutes.

I thought it was a desperate and difficult situation, and it was unlikely they would have any success at that point if there was no further mechanical support,” Cheung says.

The “mechanical support” Cheung refers to was a “ventricular-assistance device,” an implanted heart pump. And the work of St. Paul’s cardiac staff is so highly regarded worldwide that the hospital is often the first chosen for trials of new versions of such devices.

If Thurlow’s heart could be kept pumping through CPR, she might be brought back to life by surgical implantation of a heart pump. But even then, there was a strong likelihood her brain had been so deprived of oxygen that she would have suffered severe brain damage.

Thurlow was put in an ambulance for St. Paul’s. CPR continued throughout the ride. By the time Thurlow reached the hospital, she’d been undergoing CPR for more than 100 minutes. She was wheeled straight into the operating room.

Thurlow was dead, and watching from above, she says, as her body was wheeled out of Richmond Hospital to a waiting ambulance. She saw police cars — a shooting victim had just been brought in.

She saw her husband behind closed glass doors — the hospital was in lockdown while responding to the gunshot victim.

My interpretation is I was gone, or going,” says Thurlow, recalling her above-the-scene recollection.
She was still dead when she arrived at St. Paul’s Hospital in Vancouver, in spite of more than 100 minutes of CPR.

To try to save her, doctors hooked Thurlow up to a machine that would temporarily take over her heart and lung function, pumping blood out of the femoral vein in her groin, oxygenating it, and pumping it back into her femoral artery.

Doctors told Bouchard they would have to wait until the next day to determine whether oxygen-deprivation had caused brain damage.

If she sustained brain damage, it’s game over,” Bouchard recalls doctors telling him. “They’d let me say my goodbyes, and then pull the plug.”

Thurlow’s parents arrived from Calgary. The family gathered in a waiting room, terrified and tearful.

The morning brought the first inkling that Thurlow’s outcome might not be as tragic as they’d feared.

She was able to blink on command, and wiggle her toes. Doctors told the family she wouldn’t be a vegetable, but probably would have mental deficits. Meanwhile, the heart-and-lung machine could only be used temporarily before causing irreparable damage. Doctors asked the family to approve installation of a heart pump. They agreed.

Dr. Jamil Bashir slit open Thurlow’s chest, sawed through her sternum and spread apart her rib cage to install a “HeartMate 2” pump. The bracket-shaped titanium-and-Gore-Tex device, which costs $85,000, took about four hours to implant. She wouldn’t, apparently, die of heart failure. But her brain was a different matter. CPR is no substitute for the beating heart that pushes oxygen-laden blood through the brain.

After 100 minutes of CPR, we were gravely concerned that she’s going to have major neurological damage,” says Dr. Andy Ignaszewski, head of cardiology at St. Paul’s.

Eleven days later, doctors took Thurlow out of her medically induced coma. Her family, who had been taking shifts sitting beside her, anxiously awaited her response to re-awakening.

The first person she saw was her mom,” Bouchard says. Thurlow asked where Chloe and her husband were. She thought she must have been in a car accident. Her reasoning, though wrong, was an indication that her brain was functioning in what appeared to be a normal manner, Bouchard says.

We were very enthusiastic at that point,” Bouchard says.

The veteran cardiologist Ignaszewski was “amazed” at Thurlow’s level of response.

Thurlow remembers waking up and seeing her mother. But she has other memories, recollections from when she was unconscious. There was the view of her body being wheeled from Richmond Hospital. There was a vision of her body on an operating table surrounded by surgeons, and the sound of surgical instruments being laid on a tray. And there was another place, lovely and warm, from which her mother called her back.

I do believe I went to heaven,” Thurlow says. “I was in this place. It reminds me of some exotic resort. It was hot, and I could see nothing but beach and ocean and these beautiful trees. I wasn’t scared. I didn’t really see anyone else around me other than a family in the distance walking toward the sun on a dock.

Through all this I could hear my mom talking to me. I could hear her say things like, ‘Chelsie, you need to come back to us. I’m here for you.’ I heard her voice the whole time.

When I woke up and repeated it, she said she actually did say all of those things.”

A few months after the heart pump was installed, Cheung used his pioneering method to extract it without opening up her chest again. He removed the device through a small cut in her side, between two ribs. She was home within four days.

Now, Thurlow is fully recovered. Living in Surrey, B.C., with Chloe and her husband, she’s healthy, and her mind is sharp.

It is nothing short of a miracle that A, she survived this disease, and B, she got her brain back,” Ignaszewski says.

Thurlow continues taking heart medication, but has had no further trouble. Still, she says, she sometimes falls prey to fears of sudden death.

I live each day to the fullest,” she says. “Sometimes it’s a sunset or a view of the mountains, and I’ll just start crying. All those things you take for granted every day, I don’t any more.”

She remains grateful to the doctors and nurses who saved her life, including the cardiologist who told her family he’d cried over her case, a first for him in 18 years of practice.

There’s a little girl upstairs right now who has a mom, and at four-and-a-half months, she shouldn’t have,” Thurlow says.

And there’s a man who, against tremendous odds, still has his wife.

I had a strong belief in my heart that she would stay with us,” Bouchard says. “I very, very easily could have been wrong. We were fortunate to have one of the elite teams in the world as far as heart problems. Nobody gave up on her.

For that alone I’ll be thankful to those people for the rest of my life.”


Anonymous said...

A great outcome by some very dedicated people. It is nice to see happy endings.

arclein said...

Yes - that is what stands out and is so hard to achieve when giving up appears to be a rational decision. In my own case, no one wanted to believe what the MRI scans were saying because it would be an admission that a culture of swift abandonment was wrong. It was my wife who championed my survival. Now the error has been identified and the culture is changing and this allowed for this heroic fight to save this women that succeeded.

There will now be many more such efforts and perhaps the present statistic of 90% death for heart attacks outside a hospital will begin to drop.

Ephraiyim said...

The same holds true for patients with no measurable brain activity.
I worked in ICU/CCU back in the 70's and 80's when we didn't shut people off as quickly.
Every once in a while a patient that seemed to be completely "gone" would make an amazing recovery. I am a firm believer in prayer and unless the family has total peace about shutting off the machines they SHOULD NOT. No matter what the Dr.s say.
It was always the families who insisted on hanging in there who saw the "miracles" Not saying it will always happen and there is a time to let go.
I have sat with over 35 families over and the individuals dying over the years as they passed on. I am not afraid of helping people let go when the time comes.
I am only saying fight to the last possible minute until you know there is no longer any hope. Life is too precious to give up on prematurely. I have seen hopeless cases walk out of the hospital a couple of months later.

arclein said...

If there is a lesson here it is that with the heart actually operating, it is best to simply take your time. Healing does occur and a lucky combination may allow recovery. I also suspect that the extent of brain damage is way overestimated and poorly understood anyway.

A better use of medical effort may well be to stimulate the brain as it is healing. How about favorite music?

Unknown said...
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Unknown said...

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