By Dr. Rajiv Agarwal
Mr. JS, 58 years male, walked into the casualty of our hospital with chest pain for two hours. His ECG showed an extensive heat attack (an acute anteroseptal myocardial infarction).
While in the casualty, JS suffered a cardiac arrest. We started with cardiopulmonary resuscitation. Repeated shocks were given for ventricular fibrillation; he was intubated and put on ventilator and was immediately shifted to Cardiac Catheterization laboratory in deep coma. Emergency coronary angiography was done and showed completely blocked proximal LAD artery and we did a lifesaving primary angioplasty and a stent was put. The result of the procedure was excellent but patient remained in deep coma even at the end of the procedure.
JS was shifted to the Intensive Cardiac Care Unit in a comatose state where he continued to be on intra-aortic balloon pump, mechanical ventilator and inotropic support. Grave prognosis was explained to the family. Over the next two weeks, JS remained in deep coma. We suspected irreversible brain injury based on the report of MRI brain and opinion of the Neurology opinion. The family refused to give up and insisted on all efforts to save the patient.
After three weeks, JS gradually started showing signs of brain recovery including eye opening and flickers of movement.
He was weaned off the ventilator, and shifted to a ward with his family by his side. He was being fed through a jejunostomy tube (a tube attached to the midsection of the small intestine) as he was unable to take anything by mouth and he was breathing through a tracheostomy tube.
Over next one month, his feeding jejunostomy was removed. We were also able to remove his tracheostomy as he started breathing through the natural passages. His mobilization was started and he started sitting up and walking with support.
At the time of discharge , he was capable of conducting a coherent conversation.
Mr. JS went home after three months in the hospital. He improved further at home and became coherent and lucid and started going for limited work after another month!
The current guidelines of Cardio-Pulmonary Resuscitation (2016 edition) state that initially, it is difficult to assess brain damage hence patients of cardiac arrest should be treated vigorously even in deep coma without waiting for brain recovery. Recovery is , however, unlikely after 72 hours (3 days).Remarkably, our patient took 3 months to recover!
This man was our miracle, learning as well as a humbling experience for all of us. A man who made us believe in the power of prayer and faith, of determination and perseverance and ultimately in hope. A hope that we should never snatch from anyone because as someone once very rightly said, it might be the only thing he have.
—The author is a Senior Director and Unit Head, Cardiology, Max Super Specialty Hospital.