by Michael Wong
According to the Wall Street Journal:
A little known device is shaking conventional wisdom for reviving people who suffer sudden cardiac arrest: People may be able to go much longer without a pulse than the 20 minutes previously believed.
To see the Mayo Clinic video on Howard Snitzer, please click on the photo below:
This past January, Howard Snitzer suffered a heart attack outside of a grocery store in Goodhue, Minnesota. Two volunteer paramedics responded and began a 96-minute CPR marathon involving 20 others, who took turns pumping his chest.
Generally, if a victim’s pulse has not returned after 45 minutes of CPR, resuscitation is discontinued. However, fortunately for Howard, the paramedics were using capnography, a “monitoring device that measures the concentration of carbon dioxide in exhaled air and displays a numerical readout and waveform tracing.”
Research by Dr. Roger White of the Mayo Clinic and others shows that if the maximum CO2 pressure achieved during 20 minutes of CPR is 14 or less, resuscitation is almost certainly futile. If the level is above about 25, “you need to keep working at it until you’ve exhausted all of your tricks,” Dr. White said.
Based on Howard’s capnography readings, the paramedics continued and were able to resuscitate Howard after the 96th minute. Explains Bruce Goodman, a flight paramedic with the Mayo Clinic’s Medical Transport unit that was summoned to Mr. Snitzer’s aid:
If we didn’t have the CO2 readings we were getting, we would have terminated efforts much sooner.
Howard Snitzer
August 2, 2011
Response to how my recovery has been since my cardiac arrest and dramatic resuscitation.
Since hearing my own remarkable story from the Mayo One flight and Paramedic crew and subsequently from Dr. Roger White, I have come to understand the importance of Capnography as well as CPR. If Mayo One didn’t have Capnography on board the night I arrested outside of Don’s Foods in Goodhue I would most definitely not be here. That and the unrelenting efforts of the entire Goodhue Fire and Rescue crew, Mayo One, Bruce Goodman and Dr. White, which was first related to me by Bruce while I was still in a hospital gown at St. Mary’s in Rochester.
When I heard the story my first question was: “why did you keep going?” That was the first time I was told about Capnography. All I could think of to say was “Thankyou” and I only hope that I am able to honor your efforts with living a healthy life from now on. I also vowed to feed the Goodhue Fire Crew until they “begged for mercy”. I realize now that they may never want me to stop feeding them. You should see what they were eating before I got there.
I have been given a wonderful opportunity, my fifth shot at living well. Apparently I am here until I get it right. I have undergone quadruple bypass surgery and more recently a total hip replacement and am now back in the gym doing a minimum of fifty minutes of cardio every day and a good amount of cross training. As a Chef, nobody has needed to explain what a low fat diet looks like and I have continued losing weight. I think, even more importantly, I have not smoked a cigarette since the day of the heart attack, January 5, a habit I have had since I was eleven years old.
I hope that more rescue squads will acquire the Capnograph in the future. I have already heard stories about that happening as a result of people reading my story. If even one other person is helped by this then all the efforts that went into my rescue were worth it. I hope this helps thousands.
Edwin Leap, MD
August 2, 2011
I had a patient with 45 minutes of pulselessness, who was cyanotic from the neck up. Finally had return of spontaneous pulse and transferred to regional facility an hour away. Next morning, he was drinking coffee with his wife. No capnography, but it’s in the budget. I believe it’s certainly possible that our comprehension of survivability is inadequate.
Ben Garrett
August 3, 2011
I think it’s fascinating. AHA is constantly revising the CPR guidelines as we learn more. There’s also a lot of research going on in lowering the patient’s body temperature (Alsius Coolgard).
Dial Doctors
August 4, 2011
It’s amazing how such a small factor can end up saving many lives in the future. This story reminds me when I was teen watching ER and docs would ask how long they’d been trying to resuscitate. I already knew that anything over half an hour was almost sure to result in stopping treatment.
Interesting to hear they are also researching how lowering a patient’s body temperature could be used to save his life during CPR.
ppahs
August 8, 2011
The “use of capnography is going to change how we do CPR” — registered nurse comment to me.
Dave Baldwin
August 22, 2011
Thank you, Mr. Snitzer, for appreciating the gift you have been given.