Cherie will never forget the moment that her 16-year-old son, Albe, stopped breathing.
“I completely panicked,” she says. “It felt like all the air went out of the room. It just went eerily quiet.”
As Albe’s older brother, Josh, performed CPR, Cherie called 911. Albe regained consciousness briefly, then slipped away again.
It was almost impossible to believe: Just minutes earlier, the two brothers had been playing video games. Now, Albe was fighting for his life.
“I thought I was going to lose him,” says Cherie, “but at the same time, I thought, ‘No, he’s stronger than this.’ I wouldn’t even entertain the thought that we’d be without him.”
Diagnosis: massive pulmonary embolism
Josh continued performing CPR until the ambulance arrived and rushed Albe to CHOP’s Emergency Department (ED), where he went into cardiac arrest again — and dozens of clinicians from critical care medicine, hematology, cardiothoracic surgery, emergency medicine, cardiology and other specialties worked frantically to save his life.
Few hospitals have the ability to marshal so many specialists at such short notice in the middle of the night, says Robert Berg, MD, chief of CHOP’s Division of Critical Care Medicine and one of the world’s leading experts on CPR and resuscitation science. And it’s this kind of multidisciplinary collaboration that can mean the difference between life and death for patients like Albe.
“It was a major team effort,” says Berg. “Nobody does this well by themselves.”
Doctors quickly determined that blood clots were blocking the main arteries in Albe’s lungs, a condition called pulmonary embolism. The initial clot had likely developed in Albe’s left leg, which had been in a cast since he broke it playing football a few weeks earlier. When the clot traveled to his lungs, it cut off the blood flow to his organs and caused him to go into cardiac arrest. (Doctors believe that the CPR Albe received before arriving in the ED caused the initial large clot to break into two smaller ones.)
In the ED, Albe received powerful “clot-busting” medications, but his condition remained grim. His heart stopped once more before the ED team was able to stabilize him.
Ready to save a life
Each year, more than 300,000 people have a cardiac arrest, but CPR is performed in less than 20 percent of those cases. And fewer than 10 percent of people who experience cardiac arrest outside a hospital survive.
Albe was one of the lucky ones. His brother began performing CPR immediately — and he was treated at CHOP, where the survival rate for in-hospital cardiac arrest is more than 50 percent, substantially higher than the national average.
One reason for this impressive survival rate, says Berg, is that CHOP is committed to optimizing resuscitation skills. For example, every time a cardiac arrest occurs at CHOP, the entire team — including doctors, nurses and respiratory therapists — meets afterward to review video footage of the resuscitation and discuss what they would do differently next time. The result? Resuscitations are more streamlined, more organized and more effective.
The Hospital also deploys “rolling refresher” carts equipped with computerized medical manikins throughout the intensive care units and in the ED so staff can practice doing CPR right at a patient’s bedside. The manikin provides in-the-moment audio and video feedback, helping staff improve their CPR skills — so that when a patient needs their help, they’ll be more than ready.
CHOP’s CPR training efforts extend into the community as well. The Hospital’s Youth Heart Watch program helps schools implement CPR and automated external defibrillator (AED) programs, and has helped directly train nearly 100 school staff in CPR and AED use. Youth Heart Watch also conducts a screening program to identify children with serious heart conditions and places AEDs in public schools.
Josh had learned CPR years ago as part of a swim class he and Albe took at the YMCA. And when Albe collapsed in the family’s living room, it all came back to him.
“It was just instinctive,” Josh says. “I didn’t really know what was going on. It was just Albe and me.”
Care and comfort in the PICU
Once Albe was stabilized, he was moved to the Pediatric Intensive Care Unit, where he continued to receive clot-busting drugs, as well as a blood thinner. During those frightening early days, a family member or a nurse was almost always by his bedside, holding his hand. “He wouldn’t let anyone go,” says his dad, Al.
“The nurses were awesome,” says Josh. “They went above and beyond. It was good to see that he was in such caring hands.”
Follow-up care with Hematology
Albe was discharged from the Hospital after a two-week stay. Amazingly, he suffered no neurological damage from the pulmonary embolism and multiple cardiac arrests — an outcome doctors attribute to the quality of the CPR he received both at home and in the ED.
Now, he comes to the Hospital every two weeks for follow-up with members of CHOP’s Hematology team, who are working to determine if he has an underlying condition that puts him at increased risk of developing blood clots. He’ll also return in a few months for surgery to remove the plate and pins that were used to set his broken leg.
Albe’s recovery hasn’t been easy, but he’s incredibly grateful to everyone who’s been there for him — especially his brother, Josh, whose quick thinking saved his life.
“I came out of this a little bit stronger,” Albe says. “And it feels good knowing that I’m here because of him.”
Originally posted: October 2013