At the hospital where Damar Hamlin’s life was saved
CINCINNATI — Damar Hamlin, the Buffalo Bills player whose heart stopped during a game in Cincinnati Jan. 2, should not have survived if cardiac arrest statistics are any guide.
Mr Hamlin ‘was dead’ when he fell to the ground, said Dr Timothy A. Pritts, chief of the department of general surgery at the University of Cincinnati Medical Center, where Mr. Hamlin was treated.
But Safety, 24, left the hospital a week after his cardiac arrest with no apparent neurological deficits. He beat the odds after a stunning incident that traumatized his loved ones, teammates, opponents and tens of millions of Monday Night Football viewers. A visit to the hospital and to the doctors, nurses and other medical workers who helped bring him back to life illustrated the mix of good preparation and luck that allowed Mr. Hamlin to escape one of the leading causes of death in the United States .
Cardiac arrest, when the heart stops, is different from a heart attack, which occurs when blood flow is blocked in an artery supplying the heart. Outside of a hospital, more than 300,000 people suffer cardiac arrest each year, also known as sudden cardiac death. The survival rate for those who have cardiac arrest outside of hospitals and, like Mr Hamlin, have bystander CPR is just 11.2 per cent. For the few, like Mr. Hamlin, who are immediately defibrillated, the survival rate jumps to 41 percent.
Mr Hamlin’s doctors said they were unable to discuss many details of his case but were able to describe the procedures they use to treat patients like him.
“A few extra minutes or even a few extra seconds and it could have had a different outcome,” said Dr. William Knight IV, Emergency Medical Technician and Trauma Specialist at the Medical Center.
Brain damage is likely if the person in cardiac arrest goes 4 to 6 minutes without CPR and brain death occurs after 10 minutes. Only 8 percent of cardiac arrest survivors have a good neurological outcome. Most, according to Monica Sales, a spokeswoman for the American Heart Association, “have some degree of brain injury.”
Immediate resuscitation and defibrillation by medical staff at the football game, who responded quickly, was “absolutely safe” which saved Mr Hamlin’s life and brain, Dr. Benjamin Levine, a professor of medicine and cardiology at the University of Texas Southwestern Medical Center and Texas Health Dallas.
dr Levine and Dr. Jeremy Cannon, trauma and critical care specialist at the University of Pennsylvania, emphasized the paramount importance of a rapid response to cardiac arrest. Medical research to improve outcomes for cardiac arrest victims is now focused on teaching the public that CPR and the use of a defibrillator are simple and can be learned in minutes, and that many emergency responders can guide them through the procedures. The idea is to empower people to save lives.
Damar Hamlin’s breakdown
Buffalo Bills security went into cardiac arrest Jan. 2 during an NFL game in Cincinnati. He was released from the hospital on January 11.
CPR has also changed. Now it’s “hands only” – no more word-of-mouth use.
“Mission Critical #1 is blood flow to the brain,” said Dr. Charles J. Prestigiacomo, neurosurgeon at the University of Cincinnati. The brain is the most needy organ, requiring 15 to 20 percent of the body’s blood.
People are now taught to press hard on their chests 100 times a minute – singing The Bee Gees’ “Staying Alive” gets the rhythm right.
according to dr Benjamin Abella, a resuscitation expert and emergency room physician at the University of Pennsylvania, research on how to improve the odds for cardiac arrest victims has dried up. Obstacles include poor national data reporting, a lack of funding, and a lack of accountability for hospital outcomes for these patients.
Mr Hamlin’s treatment began on the pitch at Paycor Stadium, where the game was being played.
The National Football League and its teams contract with Tier 1 trauma centers — medical centers that can provide the most comprehensive care — near every stadium where they play. The University of Cincinnati Medical Center sends seven doctors to every Bengal home game. The center also sends paramedics, respiratory therapists and an ambulance crew.
As soon as Mr. Hamlin fell to the ground on Jan. 2, the medical team rushed to the field and communicated by radio because the stadium was so noisy they couldn’t hear each other talking. The air “trembled” with noise, said Dr. Brett Kissela, a neurologist at the medical center who was at the game.
And that’s how it began — an elaborate process of treating a trauma patient that requires “teams of teams,” said Dr. pritts In the first few hours, a severe trauma patient like Mr. Hamlin is physically touched by up to 50 people. By the end of the first 24 hours, that number swells to 100 people.
Established in 1823, the medical center works with the US Air Force to train military trauma physicians and medical teams. The emergency room treats around 4,800 trauma patients annually.
Those who were ready when Mr. Hamlin walked in are doctors, nurses and other medical professionals who have seen the worst of the worst. Every patient who arrives at the surgical trauma intensive care unit — where Mr Hamlin was treated — “is having the worst day of their life,” said Dr. pritts
Staff are deeply affected by their work with trauma patients.
“When I go home, I need a break. I sit alone for 15 minutes to decompress,” said Michele Hodge, a nurse who oversees the medical center’s emergency room.
Hospital workers are quick to attribute Mr Hamlin’s recovery to his youth and health. But they also credit their carefully choreographed care and experience to having an average of five cardiac arrest patients each week.
Ashleigh Schmeltzer, a CT scanner technologist, said she was reminded of Indianapolis 500 crews swarming over a car that needs attention.
In the ER, “everyone has a job and a role,” she said.
The first team to respond to a case like Mr. Hamlin’s consists of a ‘Doc Head’, a respiratory specialist who stands at the patient’s head, and a ‘Doc Foot’, the team leader, who stands at the patient’s feet. A respiratory therapist stands on one side of the patient’s head, and an attending respiratory doctor stands on the other side. Two nurses and two other doctors stand on either side of the patient while a scribe stands by and writes everything down. Two other doctors stand at the side of the stretcher.
Within minutes, the team wheel the patient into an adjoining room, where staff like Ms. Schmeltzer are doing a quick full-body CT scan.
A CT scan is so quick — it takes minutes — and is so accurate “that it’s like eyes looking inside the body,” said Dr. Mary Mahoney, professor of radiology at the medical center
A scan can’t give doctors all the information they want, but Dr. According to Mahoney, he is invaluable to the trauma team. “It can point you in the right direction.” It can show areas where fluid is pooling and can show, for example, if blood is pooling in the sac around the heart.
Although Mr. Hamlin’s heart was beating again when he reached the emergency room, he was suffering from a common complication of cardiac arrest known as Acute Respiratory Distress Syndrome, or ARDS
Because of ARDS, Mr Hamlin had to spend most of his time lying face down. When a patient has ARDS, it typically means that fluid has leaked from the blood vessels and accumulated in the lung tissue. Doctors have found that patients with ARDS are more likely to get the oxygen they need and survive if they lie face down for about 16 hours a day and lie on their back for the remaining 8 hours. The prone position, said Dr. Amy Makeley, The trauma director shifts the fluid to the lungs.
“We place patients in the prone position for as long as they need to,” said Dr. Makley, which in Mr Hamlin’s case meant from arriving in intensive care to when his doctors were able to wean him off a ventilator days later.
During this time, cooling pads were placed on Mr Hamlin’s chest and thighs to cool his body. Doctors hoped that lowering body temperature to about 92.3 degrees would help protect the brain because chemical reactions that can damage injured cells slow when body temperature drops. But patients’ bodies try to tremble, which raises the temperature, so they need to be sedated or treated with paralytic drugs.
Mr Hamlin was already sedated so he could tolerate a ventilator. He was cooled until his ventilator was removed.
For the first few days on the ward, Mr Hamlin’s doctors worried about whether he would recover at all and if so, to what extent.
But by January 4, they said in a press conference at the hospital, Mr Hamlin had started to mend. He was awake enough to communicate by nodding and shaking his head. He even wrote, “Did we win?” on a pad provided by a nurse, to the delight of the medical staff.
Finally, a week after his cardiac arrest, hospital staff sent him out of the medical center to fly back to Buffalo. dr Knight accompanied him to the Cincinnati airport.
It is still not known why Mr Hamlin went into cardiac arrest. A likely explanation was a rare event, commotio cordis, in which a blow to the chest — in his case from a tackle — at just the right 20-millisecond interval in the cardiac cycle can arrest the heart. But Mr. Hamlin’s doctors have yet to rule out other possible causes of his injury, such as a heart defect. Sometimes they never find a cause.
Medical center staff insist that all patients are treated equally – from the 30 percent who are uninsured to the wealthy donors and celebrities.
Mr. Hamlin, of course, was different.
“We’ve taken care of his illness before, but what do you do when you have to drive past 20 interview trucks?” asked Dr. Stewart Wright, the hospital’s chief physician.
Flowers and cards for Mr. Hamlin came in by the truckload, and donated meals were constantly being delivered. Outside, fans fixed placards to a chain link fence, released balloons and held candlelit vigils.
There were so many callers that the medical center had to hire extra staff, but the hospital didn’t even confirm to the callers that he was a patient.
Now the crowds and attention are gone. The hospital is back to normal and the staff breathes a sigh of relief for Mr. Hamlin. Back in Buffalo he has to recover for weeks to months.
“This is the beginning of the next phase of his recovery,” said Dr. Knight.
He added that he is beginning his own recovery from Mr. Hamlin’s episode.
“I’m exhausted,” he said.
“It was the longest week of my professional career.”