How long can a cardiac arrest patient be down and still revived without brain damage? In the case of Timea Higgins, the answer is 83 minutes—that’s how long the 43-year-old Savannah, Ga. resident lived with her heart stopped on April 8, 2020. She survived thanks to a potent combination of teamwork and technology.
Higgins’ survival and successful recovery was due to the tireless efforts of Chatham Emergency Services (CES) paramedics District Chief Doug Struble and Lt. Pam Cheek, interventional cardiologist Pablo Elizalde, MD, and the team at Savannah’s Memorial Health University Medical Center, and a LUCAS device carried in the responding CES ambulance.
This is how those 83 minutes unfolded.
Higgins didn’t know she was having a cardiac event that April morning. What she knew was, “I was sitting in my patio and had a very sharp pain in my left arm,” Higgins told EMS World on May 21st, when she remet the paramedics, doctors, and nurses who saved her life at Memorial. “I told my husband’s best friend Dan that my left arm was hurting really bad. And that’s all I remember. I do not remember anything up until I woke up in the hospital a couple of days later.”
Struble recalls what happened next: His ambulance arrived at Higgins’ home at about 7:05 a.m. He was working with Cheek, a longtime friend. “When we got to the scene, [Higgins] was lying on the floor, and we could immediately tell she was extremely sick just by her skin color,” he says. “We rolled her over to see she had agonal respirations of about six a minute. We felt for a pulse and did not feel one.”
Acting quickly, Struble and Cheek put Higgins on a cardiac monitor. It confirmed her heart was experiencing ventricular fibrillation. They shocked her. “She went into PEA (pulseless electrical activity), and my partner started chest compressions,” says Struble. “I went outside and got the LUCAS device.”
According to Stryker, which manufactures them, there are more than 24,000 LUCAS devices currently deployed around the world. CES has them in all its ambulances for delivery of consistent compressions without interruption or fatigue.
“As hard as you try, you just cannot do CPR as well as a machine can,” Cheek says. “You can do it effectively for a few moments, but it's like no workout you’ve ever had, especially if you have to do it for a while.”
In the case of Higgins, a while was an understatement. The CES paramedics had to fight long and hard to keep Higgins alive before transporting her to the hospital.
During this battle, Struble and Cheek defibrillated Higgins six times, maintained respirations with oxygen, and gave her 2 mg of epinephrine, 300 mg of amiodarone, 2 g of magnesium sulfate, and a round of sodium bicarbonate. They also placed a supraglottic airway prior to transport. After the fire department and a backup ambulance arrived, Higgins was put on a backboard and taken to Memorial.
“The entire time she was breathing, which was kind of confusing,” says Struble. “Between my partner and me, we have more than 30 years’ experience, and we were just looking at each other like, ‘She’s in v-fib, but yet she’s breathing!’” Add the various changes in Higgins’ condition the medics had to keep addressing, and “it was like God was running a mega code and pushing every single lethal arrhythmia you can imagine,” Struble says.
At the Hospital
At Memorial an ER team led by Jason Lowe, DO, took over the battle: Higgins was defibrillated three more times, intubated, and given several additional medications to stabilize her condition. Twenty minutes later this team achieved ROSC—they had successfully restarted Higgins’ heart, 83 minutes after it stopped.
With Higgins’ life saved, the team ran an EKG to find out what had happened. It showed she’d suffered a massive anterior-inferior STEMI—a heart attack so severe, it’s known as the “widowmaker.”
At this point Higgins was taken to the hospital’s cath lab, where four stents were inserted into her arteries. Elizalde had originally only intended to insert one; unfortunately, “due to all the epinephrine and drugs from the code, she started having a spasm of the left main trunk and her circumflex artery,” Elizalde says. “That’s why she required three more stents to stabilize everything. Fortunately, by the time she got to the cath lab, she was relatively stable hemodynamically, so we were able to do that.
“Within a couple of days, she was able to be extubated,” Elizalde adds. “Ten days later she got to go home. It was really sort of a miracle.”
Elizalde says the stable CPR delivered by the LUCAS device was a key element in Higgins’ survival. “She received excellent CPR the whole time,” he says. “That’s what allowed her to maintain her whole neurologic status, her kidneys, and the fact that everything else survived.”
His opinion is shared by Cheek. “There's no way a person could have done adequate CPR that long,” she says. “Having that device, I truly believe, was one of the key things that saved her life.”
This said, it also took the relentless hard work of the paramedics and ER staff. Anything less, and Higgins would not be here today.
“I was thinking the whole time, She’s younger than me—I can’t let her die! We have to give this our all!” says Cheek. “And we did, and it was amazing. That’s why I do this job and love this job.”
Higgins remains astounded by what she went through and that so many medical professionals fought so hard to save her life.
“It’s just crazy,” Higgins says. “You can’t believe it happened to you and that all these people came together to help. You don’t even know them. They’re strangers. They’re like living down the street from you, and you could have passed them in a grocery store, and yet they saved your life. So it’s really, really crazy. It’s wonderful.”
James Careless is a freelance writer and frequent contributor to EMS World.