96 minutes: When not to give up.
Circling the Drain
For 96 minutes, Howard Snitzer had no pulse. Ten days later he was walking out of the hospital due to the perseverance of an impromptu group of volunteers, trained first responders and Mayo Clinic’s flight team. The interventions that saved Snitzer’s life support two old adages; speed is life and knowledge is power.
Push Hard, Push Fast
Snitzer’s story reinforces the importance of early recognition in Life-Saving Interventions. Almost immediately after he fell, bystanders and trained first responders took turns administering hard and fast CPR. Their efforts kept blood flowing to the brain for nearly 20 minutes prior to the helicopter’s arrival. The Mayo Clinic flight teamopened an airway which helped inform the critical decision to continue resuscitation.
EtCO2 and Pulse
With no detectable pulse, Snitizer’s CO2 readings offered perhaps the only signs that he could pull through. Pulse oximetry readings, when sensors are placed on the peripheral limbs, have been said to reflect changes in the ability of a patient to oxygenate the blood slower than that of a capnography device. Capnography is the science of monitoring exhaled carbon dioxide. An acceptable EtCO2 reading indicates that the body is still able to exchange and utilize oxygen effectively, and the values provide a faster and significantly more accurate indication of the quality of perfusion throughout the entire treatment process.
Resuscitation
Throughout the process, Paramedics used the defibrillator twelve times, administered doses of epinephrine, lidocane, atropine, and after consultation, a calculated over-dose of amiodarone. After 96 long minutes, the team restored the natural rhythm of Snitzer’s heart, and flew him to the Hospital. His recovery is a shining example of how the combination of new technology and good old human perseverance can produce some incredible outcomes.
References:
American Heart Association, CPR Statistics, CPR & Sudden Cardiac Arrest (SCA) Fact Sheet, April 26, 2010
http://www.heart.org/HEARTORG/CPRAndECC/WhatisCPR/CPRFactsandS-tatistics_UCM_307542_Article.jsp
Canning, Peter, Capnography for Paramedics, December, 29, 2007
http://emscapnography.blogspot.com/
Newman, Mary, Lay Rescuer AED Programs & the 2005 Guidelines for ECC & CPR, JEMS | Heart Smarter, 30-34, 2005 via Sudden Cardiac Arrest Foundation
http://www.sca-aware.org/sites/default/files/u1/docs/Lay_Rescuer_AED_Programs_and_New_Guidelines.pdf
Newmar, Robert W., Otto, Charles W., Link, Mark S., Kronick, Steven L., Shuster, Michael, Callaway, Clifton W., Kudenchuk, Peter J., Ornato, Joseph P., McNally, Bryan, Silvers, Scott M., Passman, Rod S., White, Roger D., Hess, Erik P., Tang, Wachun, Davis, Daniel, Sinz, Elizabeth and Morrison, Laurie J., Part 8: Adult Advanced Cardiovascular Life Support : 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, Circulation, 2010
http://circ.ahajournals.org/content/122/18_suppl_3/S729
Sternberg, Steve, Dozens of people perform CPR to save one heart attack victim, USA Today 3/2/2011
http://www.npr.org/2011/08/22/139670971/when-not-to-quit-man-revived-after-96-minutes
