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.
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.