Resuscitating Life after Cardiac Arrest
April 19th, 2011 |
Categories: Brain Injury Blog Postings |
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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:
- 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.
- 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.
- 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.
In April 2010, my husband age 52, had an heart attack and was diagnosed with anoxic brain injury. I immediately retired to care for him. Unfortunately he didn’t receive the immediate care I now know he should have received. Last year he received medications, amanadine, ambien and diazepam. He recently was placed on dantrium. These meds are suppose to help him with his brain injury and muscle tone. He receives rehab in the home. I was told he can’t go into inpatient rehab until he can move on his own. I dont understand it. With prayers from church members, family and friends I am hoping that he gain at least half of what your loves have achieved. I never heard of anoxic brain injury until my husband incident. I thank you for sharing your experiences, it’s very encouraging.
This is a great blog, would you be involved in doing an interview about just how you developed it? If so e-mail me!
I found these stories very helpful. My dad was 83 years old with a bad heart and COPD when he went into the hospital for a routine hernia procedure. In spite of his health problems he was fully functional and healthy for hs age. His mind was sharp. He suffered cardiac arrest on December 27th. We were told that my father had passed away that day but they worked on him for 20 minutes and were able to bring him back. After weeks in intenstive care he was stepped down to a regular room and eventually rehab but the toll that the cardiac arrest took on him already compromised health was devastating. Once able to do everything himself he became unable to feed himself, dress himself and go to the bathroom on his own. His personality changed and he became angry mean and potentially violent to staff members or anyone that he felt antagonized by. It broke my heart to see him look at me without seeing me. His eyes were dead. Sometimes he would remember me and say he loved me but most times he was quiet and talked of things that happened long ago. Watching him deteriorate and lay in bed day after day was the most painful thing I have ever experienced. Eventually he passed away. By the time he did he bared little resemblance to the vibrant, loving, caring man that we knew and loved and while I am grateful for every extra moment we got to spend with him at I am not sure whether it was the right thing to do to bring him back to life. I have found some comfort in reading these posts to see how others have expeirenced what our family experienced. God Bless you all.
My husband was 70 years old and had a history of heart disease. A mitral valve replaced, pace maker, arithmia, But nothing could have prepared me for the cardiac arrest Oct23 /09 at the Winnipeg Convention Centre. Luckily there were security people there that had just taken the AED training and brought within 5 minutes the machine to help them as they gave CPR and waited for the ambulance to arrive. They stabalized him and send him to hospital where they put under a cold blanket to help reduce brain damage. He slowly came to in ICU and we were so lucky that he had great doctors and nurses to care for him. He stayed in hospital for 5 weeks and during that time it was noticed that he could not do somethings for himself. He was fine when it came to clothinghimself andhis hygene, but he did not always remember his family. I was happy to ssee he knew me his wife but he became very dependant on me and when I was not there he would become frantic and frightned and cause quite a stir. About 5 weeks later a neurolgist came to see him and gave him a test to see what his disablities were. He knew who I was, yes. He could follow simple directions like taking a pen from her hand with his left hand and puttin it on his right knee etc. About 30 questions in all. It was found that he qualified to go to the 8 weeks rehab for brain injuries at a Rehab hospital in Winnipeg. Thank goodness. After 8 weeks there, we went once a week to Deer Lodge Centre for day hospital and rehab for 4 months. He so despratley wanted to get his drivers license back. ( I was letting him drive the country roads)
He studied with me and did homework we got a luminosity membership online and did all kinds of tests on the computer for him. He did not manage to get his license. He had to put his loving dog down that same month and I later found out his daughters were meddling in his financial affairs, even tho I was his power of attourney and doing a fine job! This caused him more heart ache and worry. As time went on his heart started to not funtion as well and his organs began to fail. toxins in his blood ( in the elderly , it can be quite significant) caused him to become parinoid, angry, halucinate, and even a little aggresive. My husband past away in ICU 1.5 years after the cardiac arrest from renal failure. they induced a coma and slowly took him off of the supports that he was on for his heart and kidneys. I was not ready to say good bye. I thought that he would recover from this like he recovered from so many other serious health issues. He had been in ICU for 2 weeks and he had come out of a induced coma to speak with me and tell me he loved me and the next day I came in and they said they could not do anything more that I had to make a decision. Well his daughters were there and I knew because we had spoken about it many times in the 20 plus years that I was married to him that he would have wanted me to not let him linger. That was a tough decision. But really I had no choice.
On January 13, 2013 my six month old grandson with a history of Down’s Syndrome/AV Canal Defect/Laryngotracheal malesia/ grandson suffered respiratory arrest that progressed to cardio-pulmonary arrest two days after he was discarged from having a supraglottoplasty performed. Unfortunately, the paramedics arrived and chose to perform BLS on him to the emergency room. The paramedics did not assess his airway with their laryngoscope blade although both of them had known about his history of respiratory compromise. If they had, hopefully they would have been aggressive in intubating him after seeing the big glob of mucous and small amount of milk that was present in it when the ER physician visualized his airway and Lucas would have not suffered global brain damage as a result of being anoxic for at least 20 minutes. The AHA should evaluate their 2010 guidelines and NOT place airway secondary in infant cardiac arrest since their statistics reveal that most cardiac arrests in infants are initiated by respiratory arrest for Advanced Level Providers. My Downs Syndrome grandson fought for his life sevral times after his birth. He survived a blood alcohol level of .298, three times the legal limit for an adult, after being poisoned by his father with alcohol while in Ochsner Jefferson Hospital waiting for his open heart surgery on October 27, 2012 and then went through open heart surgery in early November without problems. My daughter and her father did their best to maintain Lucas’ life prior to their arrival. The paramedics knew his respiratory history. They should have been more assertive and utilized their advanced level skills as they were trained to do. I can attest to this because I’ve been one for over 30 years. I am now unalbe to continue work because my daughter needs me to help her care for her brain damaged infant. It really tears me apart having to watch my six month old grandson “posturing” with the look of “pain” on his face and us not be able to do nothing for him. According to Childrens Hospital New Orleans Neuro Lucas is too young to be prescribed the medicine to counteract the posturing and also that little research has been done on infant anoxic brain damage; therefore, little rehab that is offered to them as a result. The paramedics were fast to boast that they got a “pulse” back, BUT Lucas will never be my grandson who had “just’ Downs Syndrome again. They took what little he had left and ruined that. I will hold them accountable until the day I die.
My six year old daughter Mia had come down with a flu virus on a Friday. She was lethargic, didn’t want to eat or drink. September 9th, 2012 I had come home after running a quick errand. She was laying on the couch with my 14 year old son sitting beside her. She got up as soon as I got in the door and said she couldn’t see then ran right into one of our dining room chairs. Next thing I know she went into what looked like a seizure. A call to 911 and about 20 minutes later we were in the ER. A doctor heard an abnormal heartbeat. They tried various methods to stabilize her heart, but then she went into cardiac arrest. She required 4 hours of CPR and heart massage. She was place on ECMO then LVAD after about 5 days. Neurology was not very hopeful because she was not responding and brainwaves were very slow during the EEG test. The cause of all of this? Myocarditis. I had no idea that a virus could get into the heart.
After about two weeks, Mia began to show resistance in limbs during physical therapy. After 3 weeks she started opening her eyes & tracking people. After an MRI, we were told that her speech and walking would be affected. Mia then spent the next couple of weeks in the step down unit & then went to the rehab until November 21st when she was released.
She has since regained her walking. She regained her speech as well as her ability to read and talk. We still have therapy for her short term memory as well as her ability to focus on a single task. She has been back in school since early December 2012. Her speech therapist has said she will probably be in therapy for another 6 months. She is also at the tail end of Physical and Occupational therapies.
I guess my biggest heartbreak is remembering the “normal” child before the event. I am so thankful for what she has recovered, but we still have a road to walk.
On may 28,2011 my son age then 14 was burned 40 percent of his body with third degree burns from a fire liquid candle that exploded and set him on fire. Nine days later he went into cardiac arrest and suffered 13 minutes lack of oxygen. He is now a burn and TBI patient at Blythedale Children’s Hospital in NY . I live with my son I quit my job and he is now my job. I was told they paddled Michael twice to bring him back. He was a normal child this put him in a vegative state now 17months later he has progress though it has been emotional painful journey to witness your
Only child go through. Michael does not talk, follow things with his eyes he does not walk and thank God after being on life support is only hooked up now to feeding tube. We continue to pray and try anything to give him now 16 some kind of utile with hope
I wonder how much research has been done on cardiac arrest patients who have ROSC (Return of Spontaneous Circulation) and how many have brain damage. I hope we have more of this. Am I opposed to doing CPR if someone needs it? NO! I am glad that Ms. Cromer has asked us to learn CPR. It is a loser’s attitude to assume it won’t work. The more people know CPR and the more techniques improve the fewer people we will have suffering anoxic brain injury.
A former coworker of mine had a son who experienced anoxia due to an asthma attack. He was expected to die in the hospital that Christmas. But though his recovery from the brain injury has been slow I don’t think his mother would want him to die.
Let’s research what patient populations will likely survive intact from resuscitation. We need to let doctors (not bystanders or EMS) have more leeway in discontinuing resuscitative measures if they see the outcome as suboptimal.
My story is a bit different. It was my 90 year old father who had a massive heart attack as he climbed out of the community swimming pool. His friends tried to do CPR. Within a few minutes (witness estimates vary hugely) the fire truck arrived and they began CPR. When the ambulance arrived the EMTs were still not able to get a pulse with CPR and had to shock him twice to restart the heart. All this took at least 8 to 10 minutes.
He is/was a very young 90 and very proud to be living on his own, still driving, working out at the YMCA every day. He had an DNR but no one in the ER knew. They called my brother who lived within a 1/2 hour. By the time my brother arrived my Dad was on a ventilator. They decided to reduce his body temperature for a few days (he was comatose when he reached the ER) and then warm him up, hoping he would come out of the coma. I lived over 1000 miles away and arrived 3 days later when they were warming him.
I sat and waited. Within a day he had come out of the coma but had loss of arm and leg on right side, was unable to maintain breathing without the ventilator (it took a week before he could breathe on his own). We were prepared for the worst and amazingly, despite developing pneumonia, thrush, and a yeast infection, he seemed to be regaining some cognitive abilities. Sometimes he was lucid – threatened to sue the hospital and told everyone about his son who is a lawyer. Described where his condo was for the nurse. He remembered most names. He thought I was his sister. Never got my name and when I went home 3 weeks later he had given me the name “Shad Roe”. Who knows.
We are 2 months into the “rehab”. His physicians say he will always need 24 hour nursing. He can’t feed himself, needs to wear diapers, can’t stand, rarely knows anyone but seems to remember his youth well. Some days he sits slumped in his wheelchair picking at the vinyl covering. Sometimes he doesn’t realize he even has people in his room. While he still has a weakened aortic wall the cardiologist isn’t too worried about it.
After many CAT scans, MRIs, tests tests…the general opinion is that what we have now is what we are going to have. My brothers and I know that he should not have been revived. His friends who were there at the pool and gave him CPR have sobbed and apologized to us for saving his life.
He was old but proud of his independence, still the life of every party, had just started going on cruises and seeing the world. To see him in his current condition is killing us. He never even took prescription drugs, just vitamins. If he was aware of his condition he would hate this life. But now there is nothing we can do but wait – for either a miraculous upturn in his condition or another cardiac event to end this mess.
As my brother says “Our father died on August 5th” (the day of the heart attack). And as I said to my husband “I’ll never get to talk to my father again”.
From reading the blog posts I can see that many times there is a favorable outcome despite the anoxia. But as we all age that window of recovery shrinks. The ER never should have taken such extreme measures. The doctor told me that normally with anyone over 80 they do the minimum but because my Dad was in such amazing shape for his age they tried for that miracle.
While I’ve written up a “Living Will” and distributed copies to my family (and the rest of the world) there is still the chance that it will not be known until it is too late. For now my brothers and I just sit beside his wheelchair in silence or help feed him lunch. So much for a dignified death.
Sorry to be so negative. I’m just waiting for the nightmare to eventually end.
My son suffered cardica arrest at age 41 in June, 2011. as a result he “died” twice and was revived but was left with oxygen deprivation to the brain. It is simply amazing to me what is NOT known about anoxic brain injury- or brain injury period. His attending doctor (from the best rehab hospital in the country), said that the brain is a “big black box” and they will know how he is doing by his responses. We know so much about so many things, yet so little about the brain and it’s complexities, much less acquired brain injuries.
My husband Mike suffered a cardiac arrest on 2/18/11 on the cath lab table shortly after his cath was completed and he was told he would need double bypass surgery the following Monday. He was down for 55 minutes until full perfusion was restored. Subsequent to it, while in ICU for weeks afterward, he suffered uro-sepsis, septic shock, a retro peritoneal bleed and associated hypo-volemic shock which resulted in new, ischemic damage to the basal ganglia of his cerebral cortex. His story is outlined in my blog at the website address attached to this post…as well as a chronicle of our daily lives as we try to sort out what we have been given and move forward with grace and joy. Janet, thank you for your writing. I find something pertinent and helpful to me every time I read.