Cardiac & Resuscitation, Patient Care, Trauma

Saving Lives

Issue 2 and Volume 36.

I’ve attended hundreds of banquets and award ceremonies that have given me the opportunity to reflect on what we do in EMS that’s so special. But on Dec. 9, 2010, I had a once-in-a-lifetime opportunity to attend a banquet that transcended all of my previous experiences, an event that ignited a new fire in my personal and professional life.

The event was the “50 for 50” Golden Anniversary of CPR Survivor Celebration held at the Emergency Cardiac Care Update (ECCU 2010) Conference in San Diego and sponsored by the Citizen CPR Foundation. To recognize the 50th anniversary of the “birth” of CPR, the Citizen CPR Foundation decided to recognize the tremendous contributions made by individuals and organizations throughout the past five decades and bring together 50 cardiac arrest survivors to recognize their wonderful “rebirth.”

First, we were blessed with the opportunity to meet and honor two of the three primary contributors to the discovery and development of CPR in 1960, Guy Knickerbocker, MD, and James Jude, MD. We also heard about the work of the late William B. Kouwenhoven, MD, through his grandson.

Razor sharp and still full of enough energy to charge 1,000 defibrillators, Knickerbocker and Jude amazed and entertained us with stories of how they discovered the effectiveness of cardiac compressions, ventilations and defibrillation.

Most of their work resulted from scientific study, but some key findings occurred by happenstance in the lab at Johns Hopkins Hospital, with some inadvertent shocks jolting not only the hearts of some patients, but also the minds of the researchers.

Although it was known 50 years ago that defibrillation could restart a patient’s fibrillating heart, it took an unexpected delay in the retrieval of a defibrillator to prove that prolonged cardiac compressions truly worked. When a dog in the lab unexpectedly lapsed into cardiac arrest, Kouwenhoven had one of his young residents race up six floors to retrieve a defibrillator while another performed compressions on the lifeless animal for a previously unheard of length of time. The resident was delayed 15 minutes by a slow elevator. However, once the defibrillator arrived and was put into action, the dog returned to life with no neurologic deficit. This important occurrence resulted in further study of prolonged compressions and defibrillation of patients.

When I met everyone at my assigned table, all I initially knew was that Brian Duffield was a member of the staff of the University of Arizona Aquatic Center in Tucson. I assumed the young, vibrant 44 year old was there with his wife because he had saved one of the survivors being recognized. I soon learned that he too was a survivor, having collapsed in the locker room after a swim with his masters swim group.

It was fortunate for Duffield that Tucson Fire Dept. paramedic, Dianne Wygal-Springer was swimming at the complex at that moment, because she initiated quality CPR, used the aquatic center’s AED and had Duffield well circulated and electrically converted when her Tucson fire colleagues arrived on scene. He was transported to the Sarver Heart Center/University Medical Center, where they cooled his body with therapeutic hypothermia to reduce the chance of brain damage. He had a blocked coronary artery reopened and woke up neurologically intact four days later in his intensive care unit bed.

Another amazing save involved Vicki Meyer, who had not one but two brushes with death: once in 1984 when she collapsed while getting ready for bed and then again in summer 2004 while she was working as a volunteer feeding the homeless at a shelter in Columbus, Ohio.

In both instances, CPR-trained rescuers were immediately available to keep her vital organs perfused and oxygenated. At her home, her son and husband heard her fall and started CPR immediately. At the shelter, a fellow volunteer began CPR right away, and she was well perfused when Columbus Fire Dept. crews arrived and restarted her heart. She now has an implanted defibrillator monitoring every beat (or missed beat) of her heart.

Olivia Quigley of Winthrop, Mass., was six at the time of her cardiac arrest, which occurred while she was playing with her first grade classmates at East Boston Central Catholic School. A gym teacher summoned help, and a kindergarten and sixth-grade teacher performed CPR on her before a Boston EMS crew arrived and resuscitated her on scene. Olivia also now enjoys life with an implanted defibrillator monitoring her heart 24/7.

At the time of her arrest, Olivia’s school didn’t have an AED. It now has three, and the Quigley family has been instrumental in pushing for the passage of a Massachusetts Senate bill (2295) that will require every school to have AEDs and staff trained in CPR and the use of AEDs.

Kinlee Keltner of Morehead, Ky., was just two years old when she exited her grandfather’s swimming pool for a bathroom break and took off her “floaties.” She returned to the pool unnoticed, re-entered the water and slipped below the waterline. Luckily, her dad, a CPR instructor, was there to start CPR immediately.

Kinlee survived with no neurologic deficit and tugged at the hearts of all present at the banquet as she and Olivia walked through the center of the crowd of 500 carrying roses and handing them to Knickerbocker and Jude on stage. There wasn’t a dry eye in the house.

There was an overwhelming feeling of success that permeated the room that evening as we all witnessed the rebirth and extended lifespans of 50 survivors of cardiac arrest. That moment prompted me to spend the rest of the weekend reading about and analyzing the 50 saves that had occurred. My work was just analytic and not intended to be scientific. But I wanted to share some of my observations and similarities of success to remind you why it’s critical that you focus your efforts on the early, pre-EMS arrival care that those in a cardiac crisis should receive.

We often think cardiac arrest is a condition that strikes predominantly old persons. And, although it may be true that many of our arrests are elderly and we’re unable to resuscitate their worn, tired, hearts, these 50 survivors ranged in age from 2–70, with an average age of 44.

There were several groupings of CPR survivors (see Table 1) among the 50, with three (6%) in the 33-year-old group, three (6%) in the 40-year-old group and five (10%) in the 53-year-old group.

The combined years of life preserved by the 50 resuscitations totaled 2,183. And, using a life expectancy of 75 years, I projected that the saves extended the patients’ lives by 1,583 years.

In 56% of the cases, the survivors received CPR from bystanders who responded to their emergencies, with 18% aided by co-workers, 8% by coaches or lifeguards and 14% by family members.

AEDs also played a major role in the resuscitation of 32 (64%) of our 50 survivors. In 22 (44%), an AED was retrieved and used very early, and in 10 other instances (20%), an AED also played a role.

Each of the 50 survivors at this event was presented with a second birth certificate to acknowledge their new lease on life. I believe the similarities of success associated with these 50 resuscitations should serve as a call to action for EMS systems to get compressions and AEDs in action as early as possible to replicate these amazing results. JEMS