'Miracle': Defibrillator used to save granddad at school

September 6, 2012 by JOHN VALENTI / john.valenti@newsday.com

When Erin Cancro dropped off her daughters at school Thursday morning, it hit her just how close she had come to losing her father.
That's because her dad, Peter Clarke, 61, of Smithtown, had collapsed in cardiac arrest during drop-off Wednesday morning at Trinity Regional School in East Northport -- only to be saved by two off-duty police officers, an off-duty firefighter and a school nurse using an automated external defibrillator.
That defibrillator was hanging on a wall within arm's reach of where Clarke collapsed face-first onto the floor. The emergency responders, Northport Village Police Officer Pete Howard, MTA Police Lt. Alex Lindsay and Greenlawn Fire Department advanced life support provider Mario Geddes, all happened to be dropping off their children at the school and were standing within feet of Clarke.
"I was there this morning," Cancro said, "and I saw where he was standing and I saw where the defibrillator was and . . . I honestly have no words. To me, it's a miracle that he's OK . . . At the hospital they explained to me that, had this happened and he wasn't where he was, he wouldn't be here."
Instead, Clarke was in stable condition Thursday at Huntington Hospital, where he was taken by East Northport Fire Department ambulance.
The scene began to unfold just after 8:30 a.m. Wednesday, as children began arriving for the second day of preschool classes.
Howard, whose late father, Robert, was the Northport police chief, said he had just walked into the foyer with his 4-year-old daughter and 18-month-old son when "out of the corner of my eye I saw this man go straight as a board and fall face-first on the floor."
Howard, 41, a 16-year member of the Northport Police Department, said he ran to Clarke -- and immediately recognized him. Clarke, he said, had attended his father's funeral last year, the two having known each other from dropping off their grandkids on school mornings.
Clarke, a retired mechanic who emigrated to the United States from Ireland as a teenager, had no viable pulse, Howard said.
Howard said he called for the defibrillator and asked someone to call 911. Suffolk County police said they got that 911 call at 8:39 a.m.
Hearing the commotion, the school nurse, Kathy Schildhorn, came running from her office down the hall.
She has worked at the school nine years. Before that she said she spent 18 years as an emergency room nurse at Southside Hospital in Bay Shore.
"Mr. Howard helped position the man," she said. "Mr. Lindsay got the defibrillator out of the case. Mr. Geddes was taking down vital information."
Howard and Schildhorn positioned the defibrillator pads on Clarke's chest -- and, Schildhorn said, applied the first electric shock in an attempt to restart his heart.
Nothing.
"You have to wait between 30 and 60 seconds before you can do it again," Howard said. "It seemed like forever."
Then they shocked Clarke again, and again nothing.
Standing nearby, Trinity Principal Jeanne Morcone said she turned away, instead trying to focus on keeping arriving parents and their children from the foyer area, as Assistant Principal Patricia Ayers went outside to direct traffic and wait for arriving emergency responders.
"I saw, initially, by the way they were working on him, I thought, 'This is not good,' " Morcone said. "I knew they were working hard and there might not be a good outcome, and I didn't want anyone to be around if that was the case. I didn't want the children to see what was happening."
Then Schildhorn and Howard hit Clarke with a third shock from the AED.
To the surprise of nearly everyone, Howard said, "He just opened his eyes, looked up and said, 'What happened? What's going on here?' "
And then everyone knew.
"I thought, this is a miracle, that's what went through my mind," Schildhorn said. "I said, 'This wasn't his day. God wasn't ready for him.' "
Schildhorn said a defibrillator was so close at hand because of Louis' Law, enacted in 2002 by Gov. George Pataki.
The law was sparked by the death of Northport High School freshman Louis Acompora, 14, who died in 2000 after being hit in the chest with a ball while playing goalie in a lacrosse game. The law mandates all schools be equipped with defibrillators.
Nevertheless, Howard said he has used defibrillators about a dozen times during his career as an officer -- but, unfortunately, had never had a positive outcome. Before Wednesday, that is.
Often, he said, too much time elapsed before he was able to get in position to save a victim. This time, though, he was right there.
"I'm sure any other police officer would have done what I did," he said. "It's what we're trained to do. I'm glad he made it. It doesn't happen often, that it turns out like this."
"He's a very lucky little leprechaun," Cancro said of her Irish-immigrant father as she headed to the hospital to visit him Thursday. "Very lucky."
As Morcone, Trinity's principal, said: "We think there was an angel looking over us. Because everything was in the right place at the right time."

Longer CPR Efforts May Be Beneficial, Study Says

 

Longer CPR Efforts May Be Beneficial, Study Says

Ashley Gilbertson for The New York Times

Published: September 4, 2012

At Maimonides Medical Center, Dr. Kim-Tan Nguyen, above right, tried unsuccessfully to help revive a patient.

By RONI CARYN RABIN

When a hospital patient goes into cardiac arrest, one of the most difficult questions facing the medical team is how long to continue cardiopulmonary resuscitation. Now a new study involving hundreds of hospitals suggests that many doctors may be giving up too soon.

The study found that patients have a better chance of surviving in hospitals that persist with CPR for just nine minutes longer, on average, than hospitals where efforts are halted earlier.

There are no clear, evidence-based guidelines for how long to continue CPR efforts.

The findings challenge conventional medical thinking, which holds that prolonged resuscitation for hospitalized patients is usually futile because when patients do survive, they ofte n suffer permanent neurological damage. To the contrary, the researchers found that patients who survived prolonged CPR and left the hospital fared as well as those who were quickly resuscitated.

The study, published online Tuesday in The Lancet, is one of the largest of its kind and one of the first to link the duration of CPR efforts with survival rates. It should prompt hospitals to review their practices and consider changes if their resuscitation efforts fall short, several experts said.

Between one and five of every 1,000 hospitalized patients suffer a cardiac arrest. Generally they are older and sicker than nonhospitalized patients who suffer cardiac arrest, and their outcomes ar e generally poor, with fewer than 20 percent surviving to be discharged from the hospital.

“One of the challenges we face during an in-hospital cardiac arrest is determining how long to continue resuscitation if a patient remains unresponsive,” said Dr. Zachary D. Goldberger, the lead author of the new study, which was financed by the American Hospital Association, the Robert Wood Johnson Foundation and the National Institutes of Health. “This is one area in which there are no guidelines.”

Dr. Goldberger and his colleagues gathered data from the world’s largest registry of in-hospital cardiac arrest, maintained by the American Heart Association, identifying 64,339 patients who went into cardiac arrest at 435 hospitals in the United States from 2000 to 2008.

The researchers examined adult hospital patients in regular beds or intensive care units, excluding patients in the emergency room and those who suffered arrest during procedures. They calculated the median duration of resuscitation efforts for the nonsurvivors rather than the survivors, in order to measure a hospital’s tendency to engage in more prolonged resuscitation efforts.

One of the first surprises was the significant variation in duration of CPR among the hospitals, ranging from a median of 16 minutes in hospitals spending the least amount of time trying to revive patient s to a median of 25 minutes among those spending the most — a difference of more than 50 percent.

The researchers initially thought they would find that some patients were being subjected to protracted resuscitation efforts in vain, said the senior author, Dr. Brahmajee Nallamothu, an associate professor at the University of Michigan and a cardiologist at the Ann Arbor VA Medical Center.

But as it turned out, those extra minutes made a positive difference. Patients in hospitals with the longest CPR efforts were 12 percent more likely to survive and go home from the hospital than those with the shortest times.

Dr. Nallamothu and his colleagues found that neurological function was similar, regardless of the duration of CPR.

The patients who got the most added benefit from prolonged CPR were those whose conditions do not respond to defibrillation, or being shocked. The extra time spent on prolonged CPR may give doctors time to analyze the situation and try different interventions, they said.

“You can keep circulating blood and oxygen using CPR for sometimes well over 30 minutes and still end up with patients who survive and, importantly, have good neurological survival,” said Dr. Jerry P. Nolan, a consultant in anesthesia and critical care medicine at Royal United Hospital NHS Trust in Bath, England, who wrote a commentary accompanying the article.

Dr. Stephen J. Green, associate chairman of cardiology at North Shore-Long Island Jewish Health System, who was not involved in the study, said hospitals might have to modify their practices in light of the new research.

“You don’t want to be on the low end of this curve,” Dr. Green said. “Hospitals that are outliers should reassess what they’re doing and think about extending the duration of their CPR.”

Still, he and other experts worried that the new findings could lead to protracted efforts to resuscitate patients for whom it is inappropriate because they are at the end of their lives or for other reasons.

“There isn’t going to be a magic number,” Dr. Green said. “If you’re in there 10 to 15 minutes, you need to push higher, but as you get up higher and higher, you get to the point of very little return.”

The study authors acknowledge that their research does not indicate that longer CPR is better for every patient.

< p class="MsoNormal">“The last thing we want is for the take-home message to be that everyone should have a long resuscitation,” Dr. Goldberger said. “We’re not able to identify an optimal duration for all patients in the hospital.”

This article has been revised to reflect the following correction:

Correction: September 4, 2012

A photo caption with an earlier version of this article misspelled the name of the Maimonides Medical Center.