An Ohio man’s recovery several minutes after doctors declared him dead shows how murky the decision can be about when to stop resuscitation efforts.
While Anthony Yahle, 37, may not have been dead for 45 minutes, as was widely reported, his remarkable bounce back without suffering brain damage or other ill effects stunned doctors at Kettering Medical Center in Kettering, Ohio.
Yahle, a diesel mechanic from West Carrollton, Ohio, “coded” -- a term meaning emergency -- on the afternoon of Aug. 5, after arriving in the hospital that morning in cardiac arrest. A team of doctors rushed to his hospital bedside and used chest compressions, a bag connected to a breathing tube and medications to force blood and oxygen through his body. After 45 minutes, they gave up and declared him dead.
“He was truly flatlined at the end of that code. He had no electrical motion, no respiration, and no heart beat, and no blood pressure,” says Jayne Testa, director of cardiovascular services at Kettering.
But five to seven minutes later, the team noticed a trace of electrical activity on his heart monitor and resumed their efforts to resuscitate him. Yahle is now home recovering, according to Testa.
While Yahle "was not dead for 45 minutes," the Kettering doctors “have never seen somebody come back after the code was ended and especially after so many minutes,” says Testa.
Michael Sayre, a professor of emergency medicine at the University of Washington in Seattle and a spokesperson for the American Heart Association, says he has seen and heard of similar cases. It’s unusual but not unique, he says. Sayre doesn’t know what happened in Yahle's case, but sometimes during resuscitation air gets trapped and pressure builds in the lungs, preventing blood from flowing into the heart.
“So, I have seen once or twice where we would disconnect the bag from the breathing tube and push on the chest to let the air out, and then the patient would get a pulse and have a blood pressure because they were able to get blood back to the heart,” says Sayre.
In any case, Sayre says more hospitals may want to follow Kettering’s lead and sustain resuscitation efforts for longer than the typical 20 to 25 minutes. A 2012 nationwide study of hospitals showed that “in the hospitals where they worked for longer, they got more people back, who ended up surviving and going home,” says Sayre.
Technology can help a team decide when to stop. Most hospitals now have the ability to measure the amount of carbon dioxide in the air coming out of the patient. Carbon dioxide is a byproduct of living cells. No carbon dioxide would add to the evidence that the patient is dead. Kettering Medical Center does not continuously measure carbon dioxide levels during resuscitation.
“However, you can be faked out,” says Sayre. And sometimes even with fairly normal carbon dioxide levels, a team will stop resuscitation because “we still cannot get the heart to beat on its own,” says Sayre.
But in Yahle’s case, doctors were finally able to get his heart to beat spontaneously.
“This team did a really good job. They were able to keep his brain alive, and that’s why he survived,” says Sayre.
The Kettering doctors cooled Yahle’s body, and that may have preserved his brain function. “People can definitely go seven minutes without blood flow if the brain is cooled. That is something that is well known,” says Sayre. For example, during brain surgery, doctors cool the body and stop blood flow for even longer periods of time.
There are theories about why that works. “But no one really knows the answer to that,” says Sayre.
First published August 22 2013, 3:56 PM