Resuscitating Life after Cardiac Arrest

Brain Injury Blog by  Janet M. Cromer

April 19, 2011

Resuscitating Life after Cardiac Arrest

We’ve all heard the warning that brain cells start to die within three, four, or five minutes without oxygen. What happens when the brain doesn’t receive oxygen for forty-five minutes? A severe anoxic brain injury.

My husband Alan suffered a massive heart attack and cardiac arrest. This happened on an airplane as we awaited take-off in 1998, just before it became mandatory to have automated external defibrillators (AEDS) on all flights. A few things went right, and a few things went wrong in the crisis that ensued. It took over forty-five minutes of CPR before Alan’s heart leapt back to life. He was left with a severe brain injury that defined our lives for years to come.

Several doctors have told me that Alan had about a 5% chance of surviving that heart attack in those circumstances. That made me wonder about all the cardiac arrest survivors who are not tracked in any central registry. How many of them have anoxic brain injuries? Cardiologist say that “most” survivors have some degree of brain injury. We need much more research and treatment as more people survive cardiac arrest.

Cardiac arrest from a heart attack is only one cause of anoxic brain injury. I’ve met many people in support groups who sustained an anoxic injury from an electrical malfunction in the heart that caused a fatal arrhythmia (irregular heart beat). Others have complications from anesthesia, or a cardiac arrest during surgery. Drowning, smoke inhalation, and carbon monoxide can also prevent the brain from getting vital oxygen.
Anoxic brain injury is classified as an acquired brain injury since the cause is something going wrong inside the body, not an external force as happens in traumatic brain injury. Recently the Brain Injury Association of America added the statistic that 795,000 Americans sustain an acquired brain injury every year. That’s the first time that I’ve seen a huge figure for what I call the “forgotten” brain injuries. Acquired brain injuries don’t get as much recognition as traumatic brain injuries. The treatment for impairments is often the same, but cognitive and vocational rehabilitation services can be even harder to access.

Anoxic brain injury hits hard at the “watershed” areas of the brain that are most sensitive to any reduction in oxygen. These areas-the hippocampus, amygdala, basal ganglia, and thalamus- are involved in long-term memory, new learning, controlling emotions, and body movement.

Anoxia also causes diffuse damage which can make it harder for the brain to retrain other areas to take over lost functions. Even so, Alan made impressive progress over months and years of rehabilitation. He regained his abilities to walk, talk, read, write, and think to varying degrees.

So what is it like to come back to life after successful resuscitation? While the emergency department staff was saving Alan, I sat alone in the waiting room praying frantically and making resolutions.

I resolved to change any complaint or dissatisfaction that Alan had ever voiced about me.

Dear God, if Alan lives I’ll stop working evenings so we can have dinner together every single night. I’ll slow down my walking pace so he can keep up with me. I’ll stop “bleeding out loud” about my work stressors. I’ll take care of him in every way possible to restore his health,

 In desperation, I even vowed to give up nagging. Alan would probably tell you I never completely gave up nagging. I would say that after his brain injury I got to call it “coaching.”

For the first few years after Alan’s brain injury we celebrated July 5th as his “second birth-day.” We went out to our favorite restaurant for baked stuffed lobster and toasted his courageous determination and our shared resilience. Alan always said, “Since I came back to life, I think I deserve birthday presents on two days a year.” I made sure he received tons of presents.

As time went on, Alan didn’t want to be reminded about all the horrors he’d been through, or how many ways his life had changed. By then he was reasonably happy leading a new life with new interests and reasons for getting up every morning. We stopped the July 5th celebrations, but I shuddered as the date approached.

To me, July 5th will always be the day my husband died for the first time. And the day he came back to life.

If you or a family member has an anoxic brain injury, please share your story. We need  to raise awareness and encourage more research and treatment.

Before Alan’s cardiac arrest, we never knew that he had serious heart disease. That’s not uncommon. Here are a few steps you can take to reduce your risk:

  1. If you have a family history of heart disease, have regular check-ups, eat a healthy diet, get regular exercise, and learn to manage stress.
  2. If you have high blood pressure, follow the plan you made with your doctor. Take your medicines as prescribed, and follow a healthy life-style.
  3. Consider taking a cardiopulmonary resuscitation class in your community. Now these classes often show how to use an AED since defibrillators are placed in many public areas and can save lives. Rescuers use a defibrillator to shock the irregular heart rhythm back to a steady beat. Visit the American Heart Association for more information.

Janet is the author of Professor Cromer Learns to Read: A Couple’s New Life after Brain Injury. See Janet’s website at http://janetcromer.com/ and her blog at http://janetcromer.com/blog.

55 Responses to “Resuscitating Life after Cardiac Arrest”

  1. Janet Cromer says:

    Dear Christina,
    My heart goes out to you, your friend, and her family. Nothing can prepare us for these tragedies or the shock that follows. The family might find it helpful to talk with a member of the ethics team, or a mental health professional at the hospital to express their ideas about their mother’s wishes about quality of life. It’s very hard to bear the responsibility for making such profound decisions for a loved one, but it is also among the greatest acts of love. I will keep all of you in my thoughts and prayers.
    Janet Cromer

  2. Christina says:

    Hello everyone I decided to write in this comment area for support. I am at the hospital and one of the best friends came I0 days ago suffering chest pains. A CT scan revealed her main artery had a rip going horizontal so they did emergency surgery. A couple of days later she is talking; the next day while in ICU she went into Cardiac Arrest. It took them 6 minutes to bring her back due to her open heart surgery. She suffered injury from the bring her back, so now they are telling us that she has 7 days to remain on the machine. She will need a trache, her brain has lesions due to the cardiac arrest, she had a stroke, can”t move, she’s now blind. Wow this is crazy. Her life took a complete 360. the kids do not want the trache because she would not want this life.

    Please if you know or have any positive thoughts from an experience such as this, give them please. We are truly devastated because it’s like the doctors do not think that she will be able to breathe on her own after they take her off of the machine. So as we see it, she only has the time left on the machine to live. I am praying for a miracle.

  3. Janet Cromer says:

    Dear Vince,

    Your mother is truly an amazing lady.As Marilyn suggested, my article on hypoxic-anoxic brain injury has references at the end that might be useful. In researching the article, I was heartened to see that much more research is being done on the effects of anoxic brain injury than when my husband Alan had his cardiac arrest in 1998. More doctors are interested in the problem, although the doctors I interviewed said that rehabilitation is modeled on traumatic brain injury. A good rehab program will do more testing to identify the specific areas causing your mother’s symptoms and prioritize treatment for those areas. You might call your state Brain Injury Association/Alliance and ask for the names of neurologists and rehab specialists with an interest in HAI, at least to have a consultation. I have met many survivors of cardiac arrest over the last 15 years. Many benefited to some degree from early rehab, yet also had new problems emerge later. I wish you and your mother all the best. Every survivor needs a committed advocate!
    Janet Cromer

  4. Dear Vince,
    I am so sorry to hear of your Mom’s condition – what a hard time for all of you. There is an article by Janet Cromer on page 8 of the Summer Issue of Brain Injury Journey magazine that may be helpful – here is the link
    https://www.lapublishing.com/Brain-Injury-Journey-Free-Back-Issues/

  5. Vince says:

    My mom just suffered a cardiac arrest on 6-28 at 6pm and was without a pulse until 730pm. During that 90 min she was shocked 4 different times to get a rhythm and was placed on a ventilator. After 6 days we were told that there was no upper brain function according to the doctors. The only function she had was that of staying alive (heart beat and shallow breathing). We decided as a family to take her off the ventilator. 18 hrs later she woke up from her comma, all the doctors involved said she shouldn’t have survived. As of today her body has recovered from the heart attack (got a pacemaker), but her brain has not. She has extreme short term memory loss, and hallucinations. Are there any sites that I can visit to get more insight on damage done do to loss of oxygen and how to treat for possible recovery? I am optimistic on her recovery, after all she came back after having no pulse for approximately ninety minutes. The hospital staff are calling it a miracle. Thank you for letting me tell my story about my miracle mom.

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