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Sanjay Gupta MD
Another Day: Cheating Death
Aired October 23, 2010 - 07:30 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
(MUSIC)
DR. SANJAY GUPTA, HOST: Welcome to a very special edition of SGMD. I'm Dr. Sanjay Gupta.
You know, if you want to save a life, you need to learn CPR. The American Heart Association has introduced some brand-new guidelines.
The old way: check for a pulse, check for breathing, give artificial respirations, mouth to mouth. We can forget it.
Now, if you see someone on the ground, unresponsive, not breathing normally, you need to start pressing on their chest right away. It's not fancy, but it works. And it's part of something else: a big revolution in emergency care that's already having profoundly successful results.
You're about to see it right here in my special report: "Cheating Death."
(BEGIN VIDEOTAPE)
(BEGIN AUDIO CLIP)
JOAN BROOKS, CHRIS' MOM: Christopher?
911: 911, what's the emergency.
JOE BROOKS, CHRIS' DAD: Middletown Township.
911: What's the problem.
JOE BROOKS: My son is not responding here. He's breathing, his eyes are open. I don't know what's going on.
I don't know if he's snoring --
911: Is he awake and talking to you or not?
JOE BROOKS: No, he's not.
JOAN BROOKS: Hurry up!
911: I'm going to give you instructions. Just stay on the line.
JOAN BROOKS: Christopher! Christopher! (END AUDIO CLIP)
GUPTA (voice-over): Christopher was Chris Brooks, 22 years old, just months from college graduation. He was working construction part-time and living at home with his family.
(on camera): When that 911 call came in, he was dead -- clinically dead for 15 minutes. His heart stopped beating shortly after 3:00 in the morning on November 15, 2008.
But here's the thing. It wasn't the end. In his case and in several others that you are about to see, death was reversible.
(MUSIC)
GUPTA: The night Chris Brooks died, again innocently enough, at this bowling alley in Morrisville, Pennsylvania, a night out with a girl and his best friend T.J. Simoncini.
Was he acting differently at all? Anything unusual?
T.J. SIMONCINI, CHRIS' FRIEND: No. He was actually acting himself, you know? He's always the life of the party.
JOAN BROOKS: He's 22. He just got home from college to work for the weekend. He went bowling.
Plugged his cell phone in here and woke me up. He goes, it's just me, mom, I'm plugging my phone in. I said, OK. I said, you know, sleep here? Yes, I'll just sleep down here tonight.
GUPTA (voice-over): Moments later, there was a noise from the couch. It sounded like snoring, but his mother knew something wasn't right.
JOAN BROOKS: I went over and I bend over and I went to smack his face and he went like this, and I put my hands down on both his arms to smack his face again, and I'm like, Christopher! He said, what's that? I said, I can't wake him up.
(BEGIN AUDIO CLIP)
911: Is he breathing?
JOAN BROOKS: I don't know.
JOE BROOKS: Here, you talk!
911: Is he breathing? Yes or no?
JOAN BROOKS: Is he breathing?
JOE BROOKS: I don't know.
JOAN BROOKS: We can't tell. All right. We can't tell.
911: Tell everybody to stop screaming and listen to me so I can give you some help.
(END AUDIO CLIP)
GUPTA (on camera): Did you know what to do?
JOE BROOKS: Yes. I watch TV.
GUPTA: You watch TV?
JOE BROOKS: I started giving him mouth-to-mouth. That's all I know. And the 911 operator, he's the one who told me to stop mouth- to-mouth and straddle his chest and try to give him 60 compressions in a minute and then just keep doing it. Keep doing it. They are on their way.
911: Bare his chest and put both heels between his nipples.
JOAN BROOKS: Wait a minute. Bare his chest?
JOE BROOKS: I'm screaming, where are they? Where are they?
GUPTA: For every minute our brains go without oxygen, our chances decrease about 10 percent. Without help, Chris Brooks who had no heart beat for well over 10 minutes had almost a zero chance of survival.
(voice-over): And luckily for Chris, his father was buying him some precious time.
It was a new kind of CPR and it was pioneered right here in Arizona. It's a better way to save people whose hearts have stopped.
(BEGIN AUDIO CLIP)
911: Fire department, what's the address.
UNIDENTIFIED FEMALE: My husband's not responsive.
911: OK. What's your address?
(END AUDIO CLIP)
GUPTA: This is a call to 911 in Scottsdale, Arizona.
(BEGIN AUDIO CLIP)
UNIDENTIFIED FEMALE: Oh, my God! Oh, my God!
911: Ma'am --
(END AUDIO CLIP)
GUPTA: A 53-year-old man is in cardiac arrest and that's his wife on the phone.
(BEGIN AUDIO CLIP) 911: OK, is he breathing?
UNIDENTIFIED FEMALE: No, he's not.
911: OK, listen to me. Someone needs to start CPR. Do you have anyone there that can do CPR?
UNIDENTIFIED FEMALE: Someone?
911: Someone needs to --
UNIDENTIFIED FEMALE: Say what?
(END AUDIO CLIP)
GUPTA: Now, listen carefully to the dispatcher.
(BEGIN AUDIO CLIP)
911: You need to put him on his back.
UNIDENTIFIED FEMALE: He's on his back.
911: OK. Put the heel of your hand on his breastbone in the center of his chest.
UNIDENTIFIED FEMALE: OK.
(END AUDIO CLIP)
GUPTA: And notice what you don't hear.
(BEGIN AUDIO CLIP)
911: OK. And then you need to put your other hand on top and interlock your fingers.
(END AUDIO CLIP)
GUPTA: There was nothing in there about breaths. There was nothing about giving breaths.
(BEGIN AUDIO CLIP)
91: And you need to press straight down into his chest. OK?
UNIDENTIFIED FEMALE: OK.
911: It needs -- go quick, OK? Start counting for me.
UNIDENTIFIED FEMALE: OK. One. Two.
911: Three.
(END AUDIO CLIP)
GUPTA: You see, it's all about compressing the chest. And until just recently, that would have been unthinkable. But, it does work.
And here's why: for the first several minutes after your heart stops, your blood still has plenty of oxygen. As expert Beth Holders know, it's sort of this trick that your body plays on the mind.
Synchronized swimmers know this. You can go without breathing far longer than you think, far beyond the point when you're body is starting to scream for air.
With practice, almost anyone can hold their breath for two or three minutes. Experts can go beyond seven minutes -- seven minutes without a breath. Think about that, but only if that oxygen gets to your brain -- either pumped by the heart or by chest compressions.
Now, in most cases, a cardiac arrest, that's still not enough time. What if you could buy just a bit more? What if you could slow the clock?
GUPTA: Coming up: what you need to know to save a life.
(END VIDEOTAPE)
(COMMERCIAL BREAK)
(BEGIN VIDEOTAPE)
GUPTA (voice-over): Chris Brooks is clinging to life. His desperate father is trying to buy more time using a new kind of CPR. It's based on a new understanding between the space of life and death. And before we pick up the story, there's someone else you should meet.
(on camera): So, where are we right now?
DR. LANCE BECKER, CENTER FOR RESUSCITATION SCIENCE: So, right now, we're at the Center for Resuscitation Science Laboratories at the University of Pennsylvania.
GUPTA (voice-over): And this is Dr. Lance Becker, he's the director.
BECKER: When I trained, it's like you're alive, you're dead. It was just a sharp line between two, like going off a cliff.
Now, we know it's nothing like that. It's this gradual process. And that process means that there's an opportunity. We can do something.
GUPTA (on camera): Someone said, look, you know, don't bother with the mouth-to-mouth. I mean, you got oxygen in your bloodstream. The key is to move it around the body.
BECKER: The trick is: get as many compressions in as you can. And then if you can get a little extra oxygen in, that's fabulous. But the priority is in those chest compressions.
GUPTA: Just so I'm clear: you are saying go up there and do it as fast and hard as you can. I mean, are we talking about, 100 times a minute?
BECKER: A hundred times a minute with pretty much enough force that if you do it right, there's sweat dripping off your nose after two or three minutes.
GUPTA: Your arms are straight over the guy's chest and you are --
BECKER: Straight over --
GUPTA: Push, push, push.
BECKER: Push, push, push.
GUPTA: What you're describing could save lives.
BECKER: It has saved lives.
GUPTA (voice-over): Dr. Ben Bobrow oversees emergency services for the Arizona Department of Health. Now, when he took over in 2004, the odds of surviving cardiac arrests in Arizona were just as grim as anywhere else, less than 3 percent.
DR. BEN BOBROW, ARIZONA DEPARTMENT OF HEALTH SERVICES: We said, you know, it's hard to do a lot worse than 97 percent of the people dying.
GUPTA: One of the first things he did was change those CPR guidelines.
For paramedics in Arizona nowadays, it's 200 chest compressions in two minutes. Then defibrillation or shock four times over before giving that first artificial breath.
UNIDENTIFIED MALE: You got two minutes to learn to save a life.
GUPTA: For lay people in training courses like this one, and from 911 dispatchers, the advice is even simpler than that: Don't bother giving any breaths at all.
(BEGIN AUDIO CLIP)
911: Now what I want you to do is we're going to compression- only CPR.
(END AUDIO CLIP)
GUPTA: And within a year of Bobrow's changes, there was dramatic success.
BOBROW: In fact, statewide, the survival rate has more than tripled.
GUPTA: Just think about that: It's more than tripled.
In some parts of the state, it's even better than that. Using several new procedures including better CPR, paramedics in Flagstaff now save more than a third of the cardiac arrest victims they see.
But back in Pennsylvania, time was still running out for Chris Brooks.
Next: another novel treatment to try to keep him alive.
(END VIDEOTAPE)
(COMMERCIAL BREAK)
(BEGIN VIDEOTAPE)
(BEGIN AUDIO CLIP)
JOAN BROOKS: Come on, Chris. Come on, Chris!
911: How old is he? Twenty-two years old?
JOAN BROOKS: Twenty-two.
(END AUDIO CLIP)
GUPTA (voice-over): Joan Brooks, her son Christopher is dying right in front of her. Husband Joe is doing CPR.
JOE BROOKS: Then they say, well, do you have any heartbeat? Do you have any breath? And I'm listening, "No, I don't." And just screaming, "Where are these people?" It was taking 8 1/2 minutes -- it's a lifetime.
(BEGIN AUDIO CLIP)
JOAN BROOKS: Oh, my God.
JOE BROOKS: How close are they?
(END AUDIO CLIP)
JOE BROOKS: I don't know if you can imagine -- in second, and a second is an hour, if you know what I mean.
(BEGIN AUDIO CLIP)
JOAN BROOKS: I don't see them. They're here now.
911: Have the people come in.
JOAN BROOKS: Oh, my God. Come on, Chris! Come on, Chris!
(END AUDIO CLIP)
GUPTA: It had been more than 15 minutes since Chris' heart had stopped beating.
JOAN BROOKS: And when the medics got here, I had move to here and I was pacing up and down behind this couch here. And I just -- I wasn't -- I didn't watch them do their work.
MICHAEL HELLYER, PENNDEL-MIDDLETOWN EMERGENCY SQUAD: We started with the CPR. Adam, who was my partner that evening, shocked him.
JOE BROOKS: They hit him with the paddles and he jumps and they, nothing. Well, that is -- nothing is nothing. I don't know how to explain what nothing is, but that's not -- you know? And then they did it again, and it was nothing.
GUPTA: You see, Joan had lost three family members in less than a year -- and she was frantic.
JOAN BROOKS: I yelled at God, you took my mother, my dad and my brother. You are not taking my son. And I yelled at my mother and said, mom, you don't want your grandson up there. Don't let this happen.
HELLYER: Adam had to shock him, again. At that point, he went into an asystole rhythm which is a flat line.
GUPTA: But this is important. The paramedics didn't quit here. They gave Chris yet another shot of epinephrine and another drug, atropine, all of it to try and jumpstart his heart.
HELLYER: Adam shocked him. His rhythm converted into what we call a normal sinus rhythm.
JOE BROOKS: They gave him a needle in the heart and all of a sudden, I got a heartbeat. Whoa, out the door they went.
GUPTA: The paramedics rushed Chris to the local hospital. It's minutes away.
(on camera): Chris Brooks isn't out of the woods, not yet. Even after getting back a heartbeat, most people who suffer cardiac arrest don't make it.
(voice-over): That's because when a heart stops, a dangerous chain reaction is set into motion. It's triggered by a lack of oxygen, a chemical cascade in each and every cell, resulting in an explosion of free radicals and other dangerous elements. Once this whole thing starts going, it's hard to stop.
DR. HARRY EMMERICH, ER CHIEF, ARIA HEALTH/BUCKS COUNTY: Cell death will actually occur for 12 to 24 hours afterward, which is why we induce the hypothermia.
GUPTA (on camera): In other words, Chris' doctors would ice him down, lower his body temperature.
Here's the idea: By cooling Chris, they would put the process of death into slow motion.
(voice-over): So, doctors wrapped Chris in this special cooling blanket. But they also realized something else, he needed to be even colder and they needed a more experienced team to do that. EMMERICH: The absolute best place for him and the best chance he had for a full recovery was to be at the University of Pennsylvania.
DR. BEN ABELLA, HOSPITAL OF THE UNIVERSITY OF PENNSYLVANIA: We accepted the transfer. We got him here by helicopter as quickly as we could. Chris had been down for quite a while. In these sort of situations, people often have crippling brain injury.
GUPTA: You know, I would have thought Chris Brooks would have a terrible brain injury as well. But Abella's team was fighting back. How? By cooling his body temperature below 90 degrees. Now, on top of the extra minutes that Chris got from the CPR, it was this cold that might buy a few hours. Would it be enough?
You are looking at the Life Flight chopper with Chris inside. This photo was taken by his father.
JOE BROOKS: I took my camera out and took a picture of him as they were leaving because I couldn't go with them to the hospital.
GUPTA: Next: a crucial test.
JOE BROOKS: We won't know until he wakes up. And it depends how good you kept oxygen to the brain.
(END VIDEOTAPE)
(COMMERCIAL BREAK)
(BEGIN VIDEOTAPE)
GUPTA (voice-over): Chris Brooks, 22 years old, in critical care at the hospital of the University of Pennsylvania. He'd survived more than 15 minutes without a heartbeat. Now under heavy sedation, he's being cooled to try and ward off brain damage. Doctors kept him cool for 24 hours and then slowly, slowly started to re-warm him.
JOE BROOKS: And he's fine, except for his brain, we have no tests that can tell his brain. We won't know until he wakes up. And it depends how good you kept oxygen to the brain, depending on will he have any brain damage.
JOAN BROOKS: Prepare for the worst, hope for the best.
JOE BROOKS: And I'm not trained in CPR or anything, so this couldn't be good.
GUPTA (on camera): And you were thinking, I was the one who is --
JOE BROOKS: Well, that's what they've said. It was going to be how --
GUPTA: Did I do good enough job?
JOE BROOKS: Oh, yes. GUPTA: That's what you were thinking?
JOE BROOKS: That's how they put it.
MELISSA BROOKS, CHRIS' SISTER: When they started reheating his body and they said that, like, you know, he might start to come out of it, don't be scared if he doesn't know who you are. Don't be scared, like, you know, he obviously has been through a lot. We can't check his brain waves until he's conscious.
He started coming out of it. He couldn't talk or anything, that tube was still in his throat. And everyone's always holding his hands and stuff and like, Chris, if you can hear me, squeeze my hand. Squeeze my hand.
SIMONE WATSON, NURSE, HOSPITAL OF THE UNIVERSITY OF PENNSYLVANIA: If they can give you the two thumbs up sign, they're OK, because it's pretty high level.
JOAN BROOKS: And he had one hand under the sheet and he gave her two thumbs up. And I said that's just like my son, not to listen to what he's told.
GUPTA (on camera): There you are. I'm touching you. You are walking.
(voice-over): Six months after his heart stopped, Chris graduated from college.
Yes, he still goes bowling with his best friend, and he's got a job in Philadelphia. He's trying to save money to buy a house.
CHRIS BROOKS: I do (INAUDIBLE) plumbing and HVAC. I don't let things -- don't let this hold me back.
GUPTA: He has a defibrillator now implanted under his skin. It's actually gone off twice -- one time, it was during a pick-up football game.
CHRIS BROOKS: I was walking through the sidelines -- just boom, it hits me. My arms like this, took me right off the ground, flat faced on the grass, and just out probably for 10 seconds.
GUPTA (on camera): You got shocked?
CHRIS BROOKS: Yes, and it kicked me.
GUPTA: Wow. That's amazing.
CHRIS BROOKS: Yes.
GUPTA: And if you hadn't had that.
CHRIS BROOKS: I would have went into cardiac arrest again.
GUPTA (voice-over): At UPenn, they say cooling is a lifesaver. (on camera): I don't want to overstate this, but this literally makes a huge difference in terms of survival? This?
ABELLA: It can double the chance of brain survival.
GUPTA: This could?
ABELLA: Yes.
GUPTA: It's amazing. You know, you think about multibillion dollar drugs and that's what gets all the attention. This piece of plastic and this machine could double survival and no one talks about it.
ABELLA: That's right.
GUPTA: A lot of circumstances, you may have been declared dead.
CHRIS BROOKS: Yes.
GUPTA: What is the message, do you think for doctors, for everybody?
CHRIS BROOKS: Don't give up, I guess. Don't give up.
GUPTA (voice-over): Next, an incredible story about a woman who redefined the limits of survival. She calls it the world record that no one wants to beat.
We'll be right back.
(END VIDEOTAPE)
(COMMERCIAL BREAK)
(BEGIN VIDEOTAPE)
GUPTA (voice-over): We are north of the Arctic Circle. And this is the air ambulance team at the University Hospital of North Norway.
(on camera): Doctors here in Norway make runs like this every single day, taking care of skiers trapped in the mountains or fishermen who fall into these frigid waters. They may be among the most experienced doctors in the world in treating accidental hypothermia.
(voice-over): It was a lesson they finally mastered with Anna Bagenholm.
In May of 1999, she was going down the steep gully with two friends and fellow doctors in training, Marie Falkenberg and Torvind Naesheim.
ANNA BAGENHOLM, SKI ACCIDENT SURVIVOR: The problem is that when we come down to this frozen gully, it's a bit steep. So I hit some stones, and then I turned on my back and started to slide down the ice on my back.
GUPTA: What happened was she landed upside down with her head stuck under water between a rock and a thick shelf of ice. In fact, this is the exact spot where this all happened. Two of the men involved in Ann's rescue showed us.
KETIL SINGSTAD, RESCUER: She was where the water was. They're not deep (ph). It snow most of the year (ph), over the cliff here.
GUPTA: You can only imagine the desperation her friends must have felt as the moments started to tick by. She struggled for a while and then she stopped.
It took more than an hour and a shovel to free Anna from the ice. Torvind and Marie immediately started CPR.
As the clock was ticking, a helicopter flew Anna to the University Hospital of North Norway. It's an hour away in Tromso. She was taken straight to the operating room.
DR. MADS GILBERT, UNIV. HOSPITAL OF NORTH NORWAY: She has completely dilated pupils. She is actually waxy white. She's wet. She's ice cold when I touched her skin and she looks absolutely dead.
This is the double-edge sword. The cold was protecting her brain, it was stopping her heart, but it was protecting her brain. The brain was so cold that it did not need any oxygen.
GUPTA: And the doctors began to slowly re-warm Anna's blood.
Now, take a look at this. It's Anna's heart.
GILBERT: We just saw some little shivering and suddenly, suddenly -- it contracted. And there was a pause -- and a second contraction. Ah, everybody goes like that and we had really tearful eyes, all of us, because it was a moment of -- of victory.
GUPTA: She had no heartbeat for more than three hours. Her body temperature: 56 degrees Fahrenheit. No one has ever been that cold and then survived.
(on camera): Is it something that you take pride in? The fact that you've -
BAGENHOLM: No, no, no, no.
GUPTA: You had this -- you had this --
BAGENHOLM: No. Well, it's nice to have a world record. But I mean --
GUPTA: You have a world record.
BAGENHOLM: It's nice to have a world record that you know nobody wants to beat.
GUPTA: All right. That's a very good way of putting it.
(voice-over): Anna was paralyzed for months after the accident. It turns out that cold is devastating to your nerves, but she made a full recovery. And now, she's a radiologist at the very same hospital where doctors refused to accept that she was dead.
And in case you're curious, I was, Anna still skis those mountains where she once cheated death.
And there's something else to the story, as well. Anna and Torvind Naesheim, they were friends at the time this all happened, but in spite of this accident, or maybe because of it, they began dating. They now live together in Tromso.
(END VIDEOTAPE)
GUPTA: Well, that does it for this edition of SGMD.
Remember, lesson of the day: you see someone unresponsive, not breathing, call 911 first. Do that for help. And then arms out straight, lock those elbows, hands on top of each other, push, push, push. Don't stop even when you start sweating, keep going until the paramedics arrive. You just could just save a life.
I'm Dr. Sanjay Gupta. Thanks for watching.
