Resuscitating Life after Cardiac Arrest
April 19, 2011
Brain Injury Blog by Janet Cromer
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.