surviving a heart attack

Greg Bernhardt

How long does the average medical team work to revive someone from a heart attack? A couple weeks ago a professional footballer suffered a heart attack on the field and they worked on him for 78 minutes! When does staff call it quits? Do average medical teams stop too early? Do most doctors work to revive someone for an hour and a half?

lisab

I wondered the same thing when I read about that story. Did this footballer get an extra long attempt because of his age and level of fitness? I can't imagine they would work for so long on an elderly person, but I could be wrong.

ThinkToday

Wonder if he got a "delay of game" penalty?? j/k

Generally, we're told to do CPR until a qualified medical person (doctor) says to stop, until help arrives, or until you are exhausted and can't continue. Having a family where heart desease has a long and fatal history (4 dead and 1 survivor), I lean towards this view.

With a little research, there are apparently rare cases > 2hrs. However, this paper isn't so positive about the outcomes. http://bioethics.buffalo.edu/shortcode.ppt

berkeman

Can you post a link Greg?

The longest survival that I know about is about 90 minutes, but that was because he had a whole volunteer fire department working on him including paramedics (it was in a rural setting with a long time to the ED). He also maintained a shockable rhythm for that time, IIRC. I'm only an EMT, but I think local protocols would generally allow calling off the CPR if the EKG showed flatline for a reasonable period of time.


EDIT -- But that is only true for room-temperature emergencies. If the heart problem is associated with extreme hypothermia (like a cold-water drowning), then the patient needs to be back at room temperature before any calling off of CPR happens.

Greg Bernhardt

Here is a link to the news story
http://www.guardian.co.uk/football/2...-scott-parkers

SW VandeCarr

It's not clear from the article whether he was transported or not. I suspect he was. 78 minutes in the field with a successful outcome would be hard to believe unless it was a cold water near drowning. I also think he must have had a breathing tube inserted (intubation) early on, before being transported, and he was well oxygenated. Given he was young and generally healthy, his chances would be better than most. In hospital he might have had a pacemaker inserted by vein. This may succeed where repeated attempts at electrical defibrillation fail (sometimes because you're not dealing with a fibrillating heart, but with flat line (asystole) or electro-mechanical disassociation.)

ViewsofMars

The article implies that Fabrice Muamba stated, "I had no pain whatsoever. No clutching at my chest or tightness like you see when people have heart attacks in movies ." According to Medlineplus, 'some people do not feel any chest pain during a heart attack' and 'this is especially true of diabetic people'. http://www.nlm.nih.gov/medlineplus/t...k/ct139105.pdf

I'm somewhat skeptical about that UK Guardian article though I am glad to know that Fabrice didn't die.

SW VandeCarr

Pain or pressure sensations are typical of a myocardial infarction (MI) which involves starving cardiac tissue of oxygen because of a blocked artery. This may have been a cardiac arrest due to some defect in the heart possibly involving the conduction system. That's the more likely explanation for a young athlete who doesn't have the typical symptoms of an MI. BTW, an MI doesn't necessarily lead to a cardiac arrest. Most of them do not.

ViewsofMars

Like I earlier stated, I'm skeptical about the UK Guardian article. None of us posting to this topic were there. Furthermore, the article states, "The 24-year-old was "dead" for 78 minutes following his collapse but has already been discharged from hospital, having had an electronic device implanted in case his heart stops again." Obviously, Fabrice Muamba wasn't DEAD! If he were dead he wouldn't be alive today. What is that called, "A no brainer!" And, I'm don't deny a code Blue didn't happen.

f95toli

That time includes the time it took to get him to the hospital by ambulance AND the time it took to get his heart to beat properly once inside the trauma unit.
Also, his heart did not STOP for 78 minutes, from what I understand he had "severe arrythimia" (or whatever the medical term would be); his heart kept starting and stopping while they were working on him. The reason why he survived was -from what he doctors have said in the interviews- that they kept doing CPR and injecting him with drugs, this was apparently enough to keep the blood pumping into his brain.

Moreover, this was a pretty unusual case. Hit team doctor started CPR almost immediately after his collapse, that doctor was then joined by the 2nd team's doctor AND the ambulance crew that was on standby (there is always an ambulance present at games). A few minutes later they were joined by a heart surgeon who happened to be in the audience who then took charge and worked on him in the ambulance.
The surgeon in question is actually the head of one of the trauma teams at the hospital where they brought him (which happens to be a specialist heart hospital, one of the best in the world).

Hence, he was given the best care possible. He had 3 doctors (including a heart specialist) PLUS a trauma team working on him within minutes of his collapse AND he was taken to a specialist hospital almost immediately.
This was probably pretty much state-of-the-art trauma care. If he had collapsed at home or while training he would have died, so in many ways he was very lucky.

SW VandeCarr

Now the situation is much more clear. The hallmarks justifying a prolonged effort at resuscitation are 1) witnessed cardiac arrest 2) immediate initiation of CPR 3) ability to move quickly to advanced cardiac life support (ACLS) 4) being able to maintain ACLS in transport to a proper facility. 5) some evidence of response to treatment. (Also, cold water near drowning or cardiac arrest in other cases of significant hypothermia).

The most common cause of sudden cardiac arrest in people under 30 is hypertrophic cardiomyopathy (the heart muscle is too thick). It often goes undetected. Other causes are discussed here.

http://www.mayoclinic.com/health/sudden-death/HB00092

Abod

Our Chemistry teacher told us that he knows someone who has survived for two days
is it theoretically possible?

Bignose

Two days without blood flowing to your brain is impossible. I think with coldwater drowning the record is about 4 hours - this is because the cold causes the sympathetic nervous system to kick in immediately shunting blood flow to your brain/core, aswell the cold also slows your cellular metabolism limiting its need for oxygen. On the story... it's unlikely that the guy had a mechanical problem with his heart so you would continue to try. CPR with vasoconstrictive medications can be anywhere from 10% to 40% (with an autopulse) as effective at getting blood to your brain as the heart. There are stories of people who continue to open there eyes and look around hours after cardiac arrest so long as chest compressions continue, but there heart is dead, and unless a surgeon has an idea so are they

petm1

In my experience two hours working a corpse is about right, one hour for the field one hour in hospital. A warm body on the other hand who responds to treatment, like within 78 minutes when they stabilized the pulse, no longer needs the same care. I don't think anyone stops early.

medic 1

I have heard from people involved with this Cardiac Arrest that the London Chest deployed a device called Autopulse on Fabrice. Apparently this kept the blood flow moving feeding his vital organs whilst he had no heart beat. This seems to explain why he survived for so long in Cardiac Arrest.

zoobyshoe

http://en.wikipedia.org/wiki/AutoPulse