From Parking Lot to ICU, Quick Emergency Care Ensures a Patient's Good Outcome

CINCINNATI—Medical professionals know it as "the chain of survival:" Early Access, Early CPR, Early Defibrillation, Early Advanced Care.

It's a sequence of four steps that, when performed quickly and effectively , greatly improve the chances of survival and recovery for victims of sudden cardiac arrest.

For David Campbell, it was what saved his life Monday, June 20.

Campbell, an avid cyclist, was in Hyde Park, where he and several friends regularly met for an evening bike ride. He was in mid-sentence, telling friend Laurie Russo about his new bike shoes, when he suddenly slumped, fell off his bike and hit the ground.

"We thought he lost his balance," remembers Russo. "We thought he would pick up again talking."

But an electrical problem had stopped Campbell's heart. He was in sudden cardiac death. His heart wasn't pumping blood and he wasn't breathing.

Russo and two others immediately called 911 and started CPR—launching the first two steps of the chain of survival: early access to the emergency response system and early CPR.

"He was turning purple like I've never seen anyone do before," says Russo. "We thought, 'He's not dying in this parking lot. We are not letting him die this parking lot.' But we were pretty sure that was it."

Minutes later, Cincinnati Fire Department Engine 23 and Rescue 46 arrived and conducted the third link in the chain—early defibrillation. Russo and the other cyclists followed the ambulance to UC Health University Hospital, where Campbell was treated in the emergency medicine department by attending physician Jason McMullan, MD.

Campbell had a short course of treatment in the ER—McMullan had already alerted the hospital's catheterization lab for his arrival and, upon it, started Campbell on medically induced hypothermia to lower his body temperature and prevent brain swelling and secondary injuries.

The protocol is designed to protect comatose patients from the effects of oxygen deprivation after a cardiac arrest. Historically, patients whose brains remain without oxygen after an event that causes the heart to stop suffer poor outcomes, but McMullan says the actions of the cyclists and the paramedics reduced that risk for Campbell.

"Bystander CPR helped slow down that clock by continuing to perfuse his brain and organs before the paramedics defibrillated him," he says. "At the hospital, we can work on the heart, but once the brain is injured, we can't undo that."

The final step in the chain, early advanced care, ensured that Campbell suffered no long-term damage from his cardiac arrest.

He spent a week in University Hospital's Cardiovascular Intensive Care Unit, where the hospital's neurocritical care team worked with Jordan Bonomo, MD, to manage his therapeutic hypothermia. Bonomo, a neurocritical care and emergency medicine-critical care physician at UC Health, oversaw Campbell's recovery in the CVICU, which included a dangerous case of acute respiratory distress syndrome, a lung condition that prevents enough oxygen from being absorbed into the blood.

ICU staff used special beds to rotate Campbell, exposing healthy parts of his lungs to inhaled oxygen. They also administered inhaled nitric oxide to improve oxygen delivery. Throughout his care, Russo and his friends returned to the hospital to see Campbell and talk to his doctors.

Once his lungs recovered, Campbell underwent surgery to have an internal defibrillator implanted in his chest. If his heart experiences any future electrical disruptions, the device will shock his heart back into rhythm immediately.

"For him to make the recovery he made is just short of a miracle," says Bonomo. "He was dead in the field, in a coma upon arrival and now he's essentially back to normal. There was no delay in the escalation of care for his case—every step was done well and in a timely manner across the spectrum."

After rehabilitation at Drake Center, Campbell stayed with family before returning home, where he works designing corporate meetings and events.

Months after his attack, his only remaining side effects are a slightly slower pace as he starts riding again and a few weeks of missing memory.

"People have filled in the blanks for me," he says. "It took a long time for me to comprehend what they were talking about. But I think it's just incredible. Literally, if it had happened anywhere else, I can't imagine that the outcome would have been the same."