Saturday, October 21, 2017

Determined resuscitation

If a miracle is defined as bringing someone back from the dead, sometimes that does happen in medicine.

The Martin family believe they witnessed a miracle after their youngest son, Gardell, died last winter when he fell into an icy stream. He and his mother, father, and six older siblings live on a big rural property in central Pennsylvania that the kids love to explore. On a warm day in March 2015 two of the boys took Gardell, not quite two years old, out to play. The toddler lost his footing and fell into a stream about a hundred yards from his home. His brothers noticed that he was gone and were frantic when they couldn’t find him. By the time emergency rescuers got to Gardell—who’d been pulled out of the water by a neighbor—the boy’s heart had stopped beating for at least 35 minutes. The EMTs began chest compression, but they couldn’t get his heart to start up again. They continued CPR as they sped the ten miles to Evangelical Community, the closest hospital. He had no heartbeat, and his body temperature was 77 degrees Fahrenheit, more than 20 degrees below normal. They prepped Gardell for a helicopter ride to Geisinger Medical Center, 18 miles away in Danville. Still no heartbeat.

“He had no signs of life whatsoever,” recalls Richard Lambert, director of pediatric sedation service and a member of the pediatric critical-care team that awaited the helicopter. “He looked like a child who was … Well, he was dusky, dark colored. His lips were blue …” Lambert’s voice trails off as he remembers that dreadful moment. He knew that children who drown in ice water sometimes recover, but he’d never known of one who’d been dead for as long as Gardell had. Even worse, the boy had a shockingly low blood pH, a sign of imminent organ failure.

An emergency room resident turned to Lambert and his colleague Frank Maffei, director of pediatric critical care for Geisinger’s Janet Weis Children’s Hospital: Maybe it was time to stop trying to revive the boy? Lambert and Maffei both wanted to keep going. All the elements were as favorable as they could be in a brink-of-death story. The water was cold, the child was young, and resuscitation efforts had been started within minutes of the drowning and had continued nonstop ever since. Let’s try just a little longer, they told the team.

So they continued. Another 10 minutes, another 20 minutes, another 25. By this time Gardell had been without pulse or breath for more than an hour and a half. He was “a flaccid, cold corpse showing no signs of life,” as Lambert describes him. But team members kept pumping, pressing, monitoring. The ones doing chest compression rotated on and off every two minutes—it’s exhausting to keep doing it right, even on a tiny chest—and others inserted catheters into his femoral vein, jugular vein, stomach, and bladder, infusing warm fluids to gradually increase his body temperature. None of it seemed to be making any difference.

Rather than call off the resuscitation entirely, Lambert and Maffei decided to bring Gardell into surgery for a cardiopulmonary bypass—the most aggressive form of active rewarming, a last-ditch effort to get his heart beating. After they scrubbed up, they checked for a pulse one more time.

Incredibly, there it was: a heartbeat, faint at first, but steady, without the rhythm abnormalities that sometimes appear after a prolonged cardiac arrest. And just three and a half days later Gardell left the hospital with his prayerful family, a little wobbly on his feet but otherwise perfectly fine.

1 comment:

  1. In the middle of the meal a man’s scream suddenly pierced the air. “Help! Help! Help!!” I scrambled to find the source of the commotion and saw my neighbor holding my soaking wet son who was blue and lifeless. He had fallen into a small koi-pond near the garden and drowned. I grabbed him and assisted one of the other guests in administering CPR. Within two minutes, United Hatzalah first-responders arrived, trying to revive Elchonon who wasn’t breathing and had no pulse.

    We were able to get some of the water out of his lungs before being whisked away in the ambulance where the professionals provided much needed oxygen. With all the tools at their disposal they frantically tried to resuscitate him and get him breathing. He was not responding.

    There was deafening silence in the back of the ambulance. Then came the sweetest sound I have ever heard: a screeching, shrieking toddler. We sighed with relief.

    In a dizzying whir we arrived at the hospital where my beloved Elchonon was eventually stabilized in critical condition. He began to breathe on his own but he required oxygen and was not responsive. He had experienced hypothermia and his hands were locked into a spasm resembling someone with severe retardation, a possible indication of nerve damage or brain damage. The doctors told me that it may take a month before he begins to respond…

    Once we were transferred from the emergency room into the ICU my wife asked me, teary-eyed, “Yoshi, what is going to be?”

    “He is going to be 100 percent fine.” I refused to let go of hope despite the horrific circumstances…

    . Our hospital room was kept to arctic levels to keep Elchonon’s body temperature down to prevent further brain damage. My wife and I alternated sitting in a chair and holding our son in our arms for hours on end. I spoke to God in that chair from the deepest places in my heart. I whispered to my son, “Fight little guy, fight!” and I thought I saw a little nod…

    I was shocked when I returned the next morning. Elchonon’s hands had eased into their natural position and he was looking around! My wife told me that he tried to say “Mama” and seemed to want to walk. He was even interacting with some of the other children on the floor but she was too nervous to let him go…

    Four days after the drowning we were discharged from the hospital with a perfect bill of health. The doctors told us that they could not understand what they were witnessing. It was an outright miracle. The community of first-responders were stunned, crying tears of joy and relief…

    We were invited to a benefit concert for United Hatzalah with some of the best singers in the Jewish music world. I was asked to share our story with the thousands of people there. As I thanked God and all of His heroes for saving our son, the audience broke out in laughter -- Elchonon started performing somersaults on stage and dancing. And that was the headline in the Jerusalem Post the next day: “Miracle baby who dies on Sukkot dances on-stage five days later”.