In My Own Words

A prehospital provider's chilling experience with therapeutic hypothermic resuscitation

 

 
 
 

Robert E. Ball, EMT-P | From the State of the Science 2010 Issue


I am a paramedic who encountered the most challenging call of my career on Jan. 9, 2008—my own cardiac arrest. I was fortunate to survive because of the efforts of my colleagues, and the use of therapeutic hypothermia. This is my story.

My father died in 1969 at just 48 years of age. His cause of death was initially listed as "heart attack." However, with anecdotal information from my mother regarding the last few weeks of my dad's life, including the difficulties he had sleeping, his cause of death was determined as cardiac arrest caused by sleep apnea.

Forty years after my dad's death, I nearly succumbed to the same correctable problem. After coming home from work very late on Jan. 9, I ate a light snack and went to bed. I was so tired that I failed to put on the continuous positive airway pressure (CPAP) machine that I usually wear to counter my sleep apnea. My snoring kept my wife, Sue, awake; she decided to go downstairs to read.

At approximately 3:10 a.m., Sue decided to come back to bed. When she reached the landing at the top of our stairway, she was pleased to notice my snoring had stopped. She wasn't pleased with what she soon discovered—I was in full cardiac arrest.

Sue is a small woman and was unable to move my 250 lb. body to the floor to start CPR, so she called 9-1-1. The time was 3:20 a.m. The first responder, a police officer who luckily was just eight houses away, arrived rapidly and was soon joined by an off-duty EMT who heard the call on his pager and responded directly to the scene. They began CPR and applied an AED, but a shock was not advised.

BLS and ALS crews arrived at 3:23 a.m. I was still cyanotic but warm and unresponsive with negative carotid or radial pulses. The initial rhythm on the ALS monitor was pulseless electrical activity (PEA) with rapid A-fib. One of my regular partners intubated me and administered 1 mg of epinephrine via IV push. At 3:30 a.m., return of spontaneous circulation (ROSC) was achieved, with strong radial pulses and agonal breaths. Ventilations continued, and the crews packaged and rapidly transported me to Our Lady of Lourdes Hospital in Camden, N.J. This facility practices post-resuscitation therapeutic hypothermia. No cooling techniques were applied in the field.

It was determined that I'd been totally anoxic for at least seven minutes. I was fully postured with all indications of imminent death or total brain insult. Cooling blankets were placed under and on top of my body in the emergency department (ED). Ice packs were also placed in my groin, armpits and next to my carotid arteries. My temperature was maintained at 91º F for eight hours.

I was told that I experienced significant shivering and had to be medicated to control it. This preserved my energy and prevented the internal body heat generated from shivering. I was also told that my room was continually jammed with fire and EMS personnel (all of whom knew how to secretly enter the hospital after hours). Sue rarely left my side and had to lie across me at times to keep me from pulling out all my tubes when I started to regain consciousness.

I have no memory of the first three days after I regained consciousness with the exception of some incredibly terrifying hallucinations. At various times, I thought spiders were crawling out of my skin or water was pouring down the walls. I reportedly called my wife on the bedside phone to tell her I had checked into the Holiday Inn and was OK (I travel a lot).

I also experienced hallucinations where I thought I was on a paddle wheel boat in Pittsburgh, and once I thought I was on a cruise liner and they had moved the entertainment to my room—my roommate was watching TV when I experienced this one.

For three days, I believed a miniature man stood at the end of my bed. I could see him only in the mirror near the ceiling, but he was there. I constantly asked what had happened to me.

As time went by, I became more oriented to my surroundings and learned to trust my wife when she told me the water on the walls wasn't real. Everyone was telling me how good I looked, but when I finally got a look at my face, I was horrified. I looked awful. Everyone was telling me I looked good because they were comparing me to how I looked when I was in arrest or being cooled.

Brain insult recovery was slow, but I feel very fortunate to have recovered as well as I have. I was discharged on Jan. 18, just eight days following my "death." I've lost my entire memory of everything that happened in my life between Dec. 17, 2007 (prior to my arrest) and Jan. 18, 2008. I have no memory of Christmas, New Year's or the LSU Championship game. I have a minor problem with my balance and can't sight read music anymore. My short-term memory is noticeably reduced. Despite these challenges, I returned to EMS duty until my retirement in 2009 and continue to work full time as a bio-chemical consultant.

The physician in charge of my care told me it was miraculous how my case was handled in the field and ED. Many have referred to it as the "perfect call." But as I reflect back on the facts, I realize how very fortunate I was to have all the EMS puzzle pieces fall into place in a timely manner and that the receiving hospital was able to administer and maintain therapeutic hypothermic care.

My service now realizes the importance of the early prehospital administration of cold crystalloids and surface cooling of patients in the field. They're taking steps to make it a standard practice, which enables us to give our patients the benefit of this enhanced resuscitation process.

One last, important point: Don't start a family tradition of dying in your sleep. If you snore, go for a sleep study and avoid the chilling consequences of sleep apnea that I experienced. Four of my department members now bring their CPAP units for overnight duty. Take proactive measures to correct this controllable problem.

 

Special thanks to members of the Westmont (N.J.) Police Department, Westmont Fire Department #1, Virtua Health Systems Paramedic Service and the caring staff of Our Lady of Lourdes Hospital for their extra efforts resuscitating one of their own.

Disclosure: The author has no conflicts of interest with the sponsors of this supplement.




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Related Topics: Administration and Leadership, Leadership and Professionalism, Airway and Respiratory, Operations and Protcols

 

Robert E. Ball, EMT-PRobert E. Ball, EMT-P, is product manager for Protein Polymer Group, an American Casein Company in Burlington, N.J., and a part-time paramedic with Cherry Hill, N.J. fire department.

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