Duffield, who remained unconscious even after his heart began beating again, fully recovered within 48 hours and left the hospital within a few days, thanks to an optimized treatment protocol put in place by UA doctors of the Arizona Emergency Medicine Research Center (AEMRC) in collaboration with the Sarver Heart Center and the Tucson Fire Department.
The cardiac arrest protocol includes three phases, each critical to the patient’s chance of survival and outcome. Moments after Duffield was found, help was summoned. Dianne Wygal-Springer, a Tucson Fire Department paramedic who happened to be at the pool, tried to restore Duffield’s pulse with an Automated Electronic Defibrillator (AED). Minutes later, her colleagues responded to the call and joined her rescue efforts by performing Cardiocerebral Resuscitation (CCR), a method pioneered at the Sarver Heart Center that emphasizes continuous chest compressions.
Upon arrival at the University Medical Center (UMC) Emergency Department, Duffield still was unconscious but had a good pulse. He was wrapped in cooling pads and his core body temperature lowered to about 34 degrees Celsius (93 degrees Fahrenheit) for 24 hours. This state of induced hypothermia has been shown to improve neurological outcome following cardiac arrest and is recommended by the American Heart Association. UMC is one of the few hospitals in Arizona performing hypothermia treatment in cases of cardiac arrest.
“The precise mechanisms are still unclear, but it appears that hypothermia lessens the detrimental effects the lack of blood supply has on the body, especially the brain,” says Arthur B. Sanders, MD, professor in the UA Department of Emergency Medicine and Sarver Heart Center resuscitation expert. “Cooling also slows down the patient’s metabolic rate, which helps the body recover.”
Dr. Sanders and his colleagues are participating in a national study that compares hypothermia treatment using a device called Arctic Sun® with conventional methods such as ice packs and cooling blankets. While it is too early to favor one technique over the other, the benefits of induced hypothermia in general are encouraging.
In UMC’s cardiac catheterization lab, a team led by Sarver Heart Center member and professor of medicine Karl B. Kern, MD, reopened a blocked coronary artery that had triggered Duffield’s cardiac arrest and inserted a stent to prevent re-closure.
“Mr. Duffield’s case is a great testimony to the difference an optimized and gap-less treatment protocol like ours can make,” says Dr. Kern. “The combination of the three critical steps – Cardiocerebral Resuscitation, prompt EMS response and aggressive post-resuscitation including hypothermia and early cardiac angiography in the catheterization lab – increases the chance of a positive outcome after a cardiac arrest.”
Cardiocerebral Resuscitation (CCR) is a new approach to CPR that is easy to perform and does not involve mouth-to-mouth breathing, which makes it the ideal form of bystander CPR. By performing CCR while waiting for EMS to arrive, bystanders can greatly enhance the chances of survival for a cardiac arrest victim by keeping the blood circulating through the body.