96-minute CPR
First responders, persistence, technology save a life
Howard Snitzer will be the first to tell you he's a lucky man.
"I just wish I'd won the lottery instead," he says, jokingly. But Snitzer knows his good fortune netted him something much more valuable: his life.
Snitzer, a 54-year-old chef, miraculously survived a cardiac arrest thanks to a flawless and unrelenting response from nearly two dozen emergency personnel, including many volunteer first responders. The group took turns performing CPR on Snitzer for 96 minutes, more than 30 minutes longer than previously documented out-of-hospital cardiac arrest durations.
Snitzer's story begins one cold evening in January 2011, when he headed to Don's Foods in rural Goodhue, Minn., to buy a tank of propane for his grill. But Snitzer never made it inside. Instead, he experienced cardiac arrest and fell to the ground on the sidewalk just outside the store.
Veteran first responders
Inside Don's Foods, clerk Carol Skrypek and shopper Candace Koehn saw Snitzer fall. Skrypek immediately called 911. Brothers Roy and Al Lodermeier — veteran first responders — came running from their auto shop across the street.
Al Lodermeier and Koehn, a CPR-trained corrections officer, began performing CPR, while Roy Lodermeier went to the Goodhue firehouse to get a rescue truck and gear. Soon, volunteer firefighters, police, and rescue squads from the neighboring towns of Zumbrota and Red Wing, Minn., arrived and joined Goodhue responders. When a Mayo One flight crew landed at the scene, flight paramedic Bruce Goodman and flight nurse Mary Svoboda were stunned to see the long line of rescuers taking turns performing CPR.
"Everything had gone right before we arrived," says Bruce Goodman, a Mayo One flight paramedic. But as the minutes ticked by, Goodman began to lose hope.
Ventricular fibrillation
"We couldn't get Mr. Snitzer out of v-fib," says Goodman. "V-fib" — ventricular fibrillation — is an abnormal heart rhythm that prevents the heart from pumping blood. Electrical shocks from a defibrillator can sometimes correct the rhythm. So can certain medications. Snitzer's rescuers tried both, shocking him 11 times and pumping numerous drugs into his system. Still, the abnormal rhythm persisted.
Goodman called Roger D. White, M.D., an anesthesiologist at Mayo Clinic and expert in out-of-hospital cardiac arrest intervention, for consultation. As the teams of medical responders paramedics worked to revive Snitzer, Dr. White took four calls. "By the last call, I was pretty discouraged," says Dr. White. "We were right against the wall."
A calculated risk
Finally, Dr. White advised a calculated overdose of the heart drug amiodarone, followed by another shock with the defibrillator. The combination worked, but Goodman was concerned.
"I thought we'd revived someone who in my opinion couldn't survive what he'd been through," says Goodman. "He'd been down an hour and a half. The likelihood of him walking out of the hospital with any kind of life in my mind was zero."
But Snitzer survived.
Once his pulse resumed, Snitzer was flown to Saint Marys Hospital in Rochester, Minn., and found to have an occluded artery. A clot was removed and a stent inserted after the artery was opened. He was discharged a week and a half later showing no neurological problems from the extended period without a pulse. Shortly after, he underwent an elective bypass operation to treat his underlying heart disease.
Persistence
When Goodman, Svoboda and pilot Kyle Hansen followed up on Snitzer at Saint Marys Hospital a few days after the CPR, he was surprised — not only that Snitzer was alive, but that he was mobile. "I expected he'd be weak, sitting in his room," says Goodman. "But he was sitting out in a visitor's lounge with his brother. He stood up and greeted us when we came."
That visit marked the first time Snitzer heard the remarkable story of his rescue. "I sat there with my jaw in my lap," Snitzer says. "The first thing I said was, 'Why didn't you stop?'"
Dr. White says several factors contributed to the team's persistence.
"The cardiac arrest was witnessed, and we knew that high-quality CPR had been started almost immediately after the event," says Dr. White. "During the resuscitation, Mr. Snitzer was showing visible signs of life, including raising his arms. And we also had data that confirmed blood was flowing through his lungs to his brain."
That data was supplied by a capnograph, a feature on the team's medical monitor that measures how much blood is flowing through the lungs and, thereby, to other organs. It's frequently used to monitor patients in operating rooms, but is not commonly used by emergency personnel when treating cardiac arrest.
The value of real-time technology
"The effort was successful in large part because of capnography, which informed us that if we persisted, it was conceivable we'd have a survivor on our hands," says Dr. White. "This case shows the value of using real-time technology like capnography, which can confirm the effectiveness of CPR."
It also demonstrates the value of CPR.
"The initial intervention was key to his survival, hands down," says Goodman. "The equipment and interventions we as a flight team paramedics bring to the table are great, but we'd never have had a chance to use them if someone hadn't been getting oxygen to Mr. Snitzer's brain right away with CPR."
"To our knowledge," Dr. White says, "this episode is the longest duration of pulselessness in an out-of-hospital cardiac arrest that ended with a good outcome. The case suggests further study of advanced life support techniques is warranted, as well as the use of real-time technology like capnography that can validate the efficacy of resuscitation efforts." Though he doesn't relish the spotlight, Snitzer continues to tell his story as a way to help spread the word about CPR.
"After surviving this, I'm still trying to figure out what my purpose is," he says. "I know I want to help whoever I can, and to do something meaningful. Hopefully telling my story will give a new jolt to CPR."
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