When Howard Snitzer clutched his chest and crumpled on a freezing sidewalk outside Don's Foods in Goodhue, Minn., he was wearing gym shorts, fresh from his daily workout. Across the street, at Roy and Al's Auto Service, the Lodermeier brothers were getting ready to close. A local high school teacher ran up.
"He said a guy had fallen on the sidewalk," Al Lodermeier says. At that moment, Don Shulte, owner of the grocery store, walked in. The three ran back to where Snitzer lay on the sidewalk. He wasn't breathing. He had no pulse. If he didn't get help soon, he would die.
For the next 96 minutes -- more than an hour and a half -- Al, his brother Roy, bystander Candace Koehn, who saw Snitzer fall, and more than two dozen other first responders took turns performing CPR on the fallen man. Their teamwork saved Snitzer's life in what may be one of the longest successful out-of-hospital resuscitations ever.
What makes the incident even more striking was that it took place in rural Goodhue, population about 900, a town without a traffic light.
"It's remarkable," says Bruce Wilkoff, a heart rhythm specialist at the Cleveland Clinic. "It's a great example of people doing the right thing and having it work out."
Along with the Lodermeier brothers, both veteran first responders with more than three decades of experience on the volunteer Goodhue Fire Department, Snitzer's rescuers included police, volunteer firefighters and rescue squads from the neighboring towns of Zumbrota and Red Wing. The Mayo Clinic's emergency helicopter, Mayo One, flew in from Rochester, Minn., almost 35 miles away.
Their teamwork kept blood flowing to Snitzer's brain, making each rescuer a surrogate for his failing heart.
"The brain survives, at best, five or six minutes when the blood flow stops," Wilkoff says. Nationwide, only about 5% of people who suffer cardiac arrest on the street are resuscitated and leave the hospital, he says.
"I don't think the story's about me," says Snitzer, 54, who suffered his cardiac arrest Jan. 15 and spent 10 days in the hospital. "It's about the guys in Goodhue and Mayo One."
"The No. 1 thing in this case was that someone recognized very quickly that (Snitzer) had arrested and began good, hard, fast CPR," says Mayo One paramedic Bruce Goodman, who arrived about 20 minutes after Snitzer's 5 p.m. collapse.
During the course of the emergency, first responders shocked Snitzer a dozen times to jolt his heart out of its abnormal rhythm, or ventricular fibrillation. Ventricular fibrillation occurs when the heart's electrical circuits begin firing randomly, so the heart quivers and can't pump blood.
Goodman and Mary Svoboda also gave Snitzer intravenous drugs to try to restore his heartbeat to normal. When he didn't respond, he called Mayo cardiac-arrest expert Roger White on his cellphone for guidance. Ultimately, they agreed to try a calculated overdose of a heart drug, amiodarone. It worked.
"My end of this bargain is to honor the guys who did this for me," says Snitzer, who didn't know the details of his rescue for several days. When they met in his hospital room, Goodman says, he was stunned to see a man he didn't think would survive sitting up and talking with his brother.
He asked Goodman: "Why didn't you stop?"
It's a question, Goodman says, for which he still doesn't have a good answer.
A New Face In Town
Howard Snitzer, an unemployed chef, says he is a relative stranger in Goodhue. He moved there just a few months ago to live with his girlfriend, Tammy Ryan, whose husband of 22 years died of a heart attack at home.
His survival reflects a triumph over doubt as much as perseverance. The first responders who raced to Snitzer's assistance knew when they arrived that the odds were stacked against them -- and him.
"We've never had a case when we could save anybody, because we were never this close," says Roy Lodermeier. "This is the first case I know of, of someone who walks and talks and is getting around like (Snitzer) is."
Even cities with the best records of responding to out-of-hospital cardiac arrests -- places such as Seattle and Mayo's home city of Rochester -- save fewer than half of all victims, about 45% at best, if the cardiac arrest is witnessed by a bystander, says Roger White, a leading expert in cardiac arrest and co-director of Mayo Clinic's emergency transport team, which includes Mayo One.
Survivors sometimes suffer brain damage, White says, "a very compelling concern" in Snitzer's case.
"If you'd told me that night that this guy was going to get up and walk out of the hospital," says Mayo One's Goodman, "I would probably have said, 'I'll bet my house against yours he won't.' "
Location Was Vital
Snitzer's first bit of good luck was that he dropped practically on Al and Roy Lodermeier's doorstep. Al began CPR while Roy Lodermeier detoured to the firehouse to get the rescue truck, with all of its emergency gear, before rushing to the grocery store.
Another was the presence of Koehn, a CPR-trained corrections officer at the Goodhue County Adult Detention Center, who was in the store and watched him fall. She helped as Al Lodermeier dragged Snitzer inside and cut open his shirt with borrowed scissors. The two started CPR. "This is the first time I've ever had to do a rescue," she says.
He was also lucky that the weather had cleared so Mayo One could respond to the call.
"If he had collapsed earlier in the day, we might not have been able to get to him," Goodman says.
When the helicopter landed at the firehouse, Goodman and Svoboda found Snitzer inside. He had been moved moments earlier by first responders who, as their numbers increased, found that they were running out of room in the grocery store.
The rescuers hefted Snitzer, a 220-pound man, to a gurney and rolled him to an open bay at the fire hall.
The Mayo One crew found a line of first responders taking turns pumping on Snitzer's chest. Al Lodermeier was at Snitzer's head, squeezing air into a mask over his mouth using a device called an ambu bag.
"They were having trouble putting in an IV line to get drugs into him," Goodman says. "We put in a breathing tube." The airway turned out to be a key component of the decision-making to follow, because it measured carbon dioxide -- a byproduct of breathing that revealed oxygen was reaching Snitzer's brain.
Goodman and Svoboda began administering drugs: epinephrine, lidocaine, atropine and amiodarone, which they hoped would restore Snitzer's normal heart rhythm.
It did not.
Goodman called an emergency doctor at the Mayo Clinic, who told him that the rescue was probably futile. Goodman says he had his own doubts.
Instead, he called White, who had helped to train him. He would call him four times. White said to keep going. "I must say, I was feeling increasingly desperate," White says, but the evidence that Snitzer was taking in oxygen and expelling carbon dioxide reassured him that Snitzer might make it.
"We weren't at a point where we could give up yet."
White suggested another dose of amiodarone, 150 milligrams more than is recommended for a second dose. Goodman had run out. He borrowed more from the Red Wing rescue crew.
"Many things were going through my head at that point," he says. "This gentleman has not had a pulse for over an hour. He's unlikely to survive even if we can get a rhythm. Is this something we should call off?"
He gave him the drug. Soon, he felt a pulse. White cleared him to load Snitzer on the helicopter and fly to Mayo's St. Mary's Hospital.
But Goodman still thought Snitzer wouldn't survive, or he might wind up in a vegetative state. "I wasn't feeling we did a great thing," Goodman says. "More like, 'Oh boy, what did we do?' "
Lots Of Cooking To Do
Snitzer spent 10 days in the hospital. Doctors there cleared a blood clot from a critical artery and propped it open with a stent. The early reports on his condition were "pretty dismal," Goodman says. "When I came to work five or six days later, I looked him up to see when he had died. I found out he had a room number."
Goodman and Svoboda went down to see him and told them for the first time what occurred. Snitzer says he's still sore from the CPR and weak from the heart attack. But he's extremely grateful to all the people who saved his life. "I'm a chef. I told them I'd be fattening them up every chance I get."
On Tuesday, White flew to Goodhue to attend the monthly meeting of the Goodhue Fire Department and offer a seminar on the case. Snitzer and Ryan went, too -- and Snitzer met White for the first time.
"I was floored," Snitzer says. "He hugged me for a long time. He wouldn't let go."