Headlines
As reported by The Hartford Courant, October 24, 2010.
Anatomy of a Cardiac Rescue
A Man's Heart Goes into Arrest, and Lifeguards' Training and an External Defibrillator Are Put to the Test
By Vanessa De La Torre
Lifeguard Sam Allison poked and pinched. He shouted at the man whose 238-pound body was wedged between a treadmill and elliptical machine in the fitness room at Cornerstone Aquatics Center.
The man's face was tinged blue, and the lone signs of life were violent gasps that sounded like loud snoring. That noise was dwindling.
Less than a minute earlier, Trinity College history Professor Eugene Leach had collapsed from sudden cardiac arrest, a leading cause of death in the United States. Only about one of 10 people who are stricken outside of a hospital have any chance of surviving.
The actions that Allison and two other young lifeguards took over the next four minutes were critical in determining whether Leach, 66, would ever regain consciousness, doctors and emergency personnel say.
Weeks later, West Hartford officials are pointing to the Sept. 16 episode as proof that automated external defibrillators — the portable, heart-shocking devices often located in public buildings — and performing basic CPR can make the difference when seconds matter.
The emphasis coincides with new guidelines for cardiopulmonary resuscitation just released by the American Heart Association: In most cases, bystanders should give only chest compressions to an adult who might be in cardiac arrest and not try mouth-to-mouth resuscitation.
"It's important that anybody, anybody, learns CPR," said Gary Allyn, West Hartford's assistant fire chief. "It could be a loved one or a stranger whose life you save."
'A Curveball'
At 4 p.m. on Sept. 16, Allison, a 22-year-old lifeguard from West Hartford, had just gone off duty and was chatting with fellow lifeguard Carter Hatton when a man hurried out of the Cornerstone fitness room.
Town resident Russell Sirman had been doing sit-ups when he heard a thud behind him, by the treadmills. It didn't register at first — then came "an odd sound, like someone snoring away," recalled Sirman, 46, a teacher at Classical Magnet School in Hartford.
"Sir, are you all right?" he asked Leach. Within moments of the initial thud, Sirman ran to the lifeguards standing near one of the center's pools.
"It only takes a half-second between seeing him coming and knowing whether it's going to be a serious problem," Allison said.
The night before, Allison had grumbled to pals about his "uneventful" life. He graduated from the University of Connecticut a few months ago as a history major, and didn't think he'd be back at Cornerstone, a town-owned swimming center operated by the company Aquatics for Life. In his six years as a part-time lifeguard, Allison told his friends, "I've never even had to pull someone out of the water."
But now Allison and Hatton, 19, were beside the unconscious man, a West Hartford resident and Cornerstone regular who had been running the treadmills three times a week for the past seven years to strengthen his heart.
Somehow, Leach became lodged between an elliptical machine and a treadmill after his collapse.
"That was a bit of a curveball," said Hatton, of Farmington, who had only been on the job for several months.
Hatton radioed for the front desk to call 911. Not long afterward, Dan Stowe walked past the desk on his way to give private lessons at one of the pools. Stowe, a 28-year-old veteran lifeguard from South Windsor, ran to the fitness room. Allison, Hatton and Sirman had already pushed the exercise machines apart and pulled Leach to the center of the room.
As the younger lifeguards checked for vital signs, Stowe ran to get the automatic defibrillator stationed about 40 feet away.
Allison and Hatton were initially wary of moving Leach in case he had a spinal injury from the fall. But his face was turning a deeper blue, and his hoarse breathing sounded as though it would cease in a matter of seconds.
The two began a round of CPR — Hatton gave roughly 30 chest compressions and Allison attempted to give two rescue breaths — as Stowe returned with the defibrillator less than two minutes after Leach's collapse. To prepare for the defibrillator, Hatton cut open Leach's shirt.
That's when they saw the long scar down Leach's sternum. The college professor had undergone major heart bypass surgery 10 years ago.
His rescuers now presumed he had experienced either a heart attack — when one or more of the arteries is blocked — or cardiac arrest, a different event in which the heart abruptly stops beating and blood pressure drops to nothing, halting blood circulation and oxygen to the brain and other organs. Ventricular fibrillation, when a heart rhythm suddenly becomes uneven and chaotic, typically causes cardiac arrest.
Those with a history of coronary disease are more likely to be stricken.
"I had very, very little expectation of him surviving this," Allison said.
Fortuitous Events
The automated external defibrillator, or AED, is able to analyze a victim's heart rhythm and determine whether to administer a shock. To make it easy for a bystander, the machine announces each instructional step with audible or visual commands.
West Hartford began placing AEDs in firetrucks 12 years ago and has installed about 35 of the devices in schools, town hall, golf courses and recreational centers since 2002, officials said. Emergency personnel attribute at least 100 saved lives to the machines over that span of time.
"Before this program, for every 100 people in West Hartford who had a heart attack, only about two or three of them had any chance," Fire Chief William Austin told the town council recently. "Now six to eight might have a chance."
But bystander use is rare. Allyn, the assistant fire chief, said he believed Leach's case of cardiac arrest marked the first time that people working in a town-owned building had to use one of the stationed defibrillators.
Stowe has been a lifeguard for 10 years, but never had to resuscitate a victim until Sept. 16.
The AED instructed him to administer the electric current. "I hit the button," Stowe said; Leach's body appeared to jolt. "After the shock, you could actually see color going back to his face.
"This individual, Eugene, was definitely a fighter, because he was struggling," Stowe said, "and he kept struggling."
The electric current reorganized Leach's heart rhythm enough to keep him faintly breathing. Hatton continued chest compressions as Allison and Stowe attempted to give rescue breaths.
"Four minutes, three seconds after the call came in, we were on scene and paramedics were behind us," Allyn said.
The emergency medical technicians took over and injected Leach with heart stimulants, intubated him to open his airway, and shocked him four times with their own defibrillator before rushing him to the University of Connecticut's John Dempsey Hospital.
Leach was comatose and on life support as a team of doctors and nurses performed emergency procedures that included hypothermic therapy — lowering his body temperature to 92 to 94 degrees for 24 hours using ice packs and infusing saline to help the brain recover.
"The biggest tragedy in this situation is we're able to resuscitate, keep the heart beating again, but they are left with neurological damage," said Dr. Jason Ryan, one of the UConn Health Center cardiologists who treated Leach. "They aren't the same person when they wake up."
The morning Leach was eased back into consciousness, he began reading The New York Times.
Six days after the collapse, Leach was released from the hospital with full neurological recovery and an internal defibrillator installed in his chest.
"Four hundred and fifty thousand Americans die a year because of how Leach almost died," said Dr. Christopher Pickett of UConn's Calhoun Cardiology Center. He estimated Leach's initial chances of survival were between 5 percent and 7 percent. The immediate chest compressions at Cornerstone kept blood circulating to the brain, and likely helped his heart respond to the defibrillator shocks.
"The lifeguards are really heroes," Ryan said.
'Fell Over Like A Tree'
I approached that far country from which no traveler returns ...
— Trinity College Professor Eugene Leach in a Sept. 29 e-mail to colleagues
Leach remembered running on the Cornerstone treadmill, engrossed in an audio book of Tolstoy's "Anna Karenina" streaming through his earbuds.
"A really beautiful reading of a great novel, and I was having a great time," Leach said from his West Hartford home. "Then I fell over like a tree."
The professor is taking it easy now. The five days after the cardiac arrest are lost somewhere in his memory, but he is gaining strength and has shed at least a dozen pounds.
He goes for walks with his Labrador retriever, Melanie, in their Beverly Road neighborhood. Although on medical leave from Trinity, he has resumed his detailed, written critiques of master's theses, and has returned to his own book project on Abraham Lincoln, Frederick Douglass and the American dream.
About a week ago, Leach and his wife, Kathy Frederick, met Allison, Hatton and Stowe in the Cornerstone lobby and gave each an iPod Nano, colored red for the heart, as a small token of their thanks.
"No band, no banner," Leach said. "They didn't make speeches. They assured us that they did what they were trained to do."