Rescue after 20 minutes under water
Intensive care medicine(28.10.2016) A young man suddenly collapses while swimming in the Rhine and sinks to the bottom of the river. Only after 20 minutes is he brought to the surface and after a further ten minutes of resuscitation does his heart begin to beat again. Contrary to all probability, he not only survives, but suffers only minimal consequential damage. Intensive care physicians from the University Medical Center Freiburg played a major role in this.
It is the hottest day of 2016 in Constance when a group of young adults decide to go swimming in the Rhine. But suddenly, 19-year-old Abdul A.* collapses and sinks to the bottom of the river. His companions immediately call the rescue services, including divers from the DLRG (Deutsche Lebens-Rettungs-Gesellschaft e.V.). They discover the young man at a depth of eight meters. Abdul A. was rescued 20 minutes after the accident. After ten minutes of resuscitation, his heart begins to beat.
Only one in ten survives ten minutes without oxygen
30 minutes is very quick for a complex water rescue, but a lack of oxygen lasting this long is usually fatal. On average, only one in ten people survive a ten-minute cardiac arrest. After 25 minutes, there is usually little hope. If those affected still survive the accident, they usually suffer from severe brain damage for the rest of their lives.
488 people drowned in Germany in 2015, the highest number in the past eight years. Drowning is even the second most common cause of death among children under the age of five.
Natural hypothermia as a lifesaver
"The patient was probably lucky that the water in the depths was 19 degrees Celsius cold and cooled his body temperature to 32 degrees," says Dr. Johannes Kalbhenn, senior physician at the Department of Anaesthesiology and Intensive Care Medicine at the Freiburg University Medical Center. Doctors have known for some time that mild hypothermia can save lives in emergencies. At the University Medical Center Freiburg, cooling vests are therefore specifically used in intensive care therapy to reduce the body temperature from just under 37 degrees to between 36 and 33 degrees. The procedure is called hypothermia.
Hypothermia as a tool in intensive care medicine
"We also use this effect in major operations on the aorta by first slowly cooling the patient down and only then cutting off the blood supply to the brain for a while. The cells then enter a kind of hibernation," explains Dr. Kalbhenn. Below 30 degrees body temperature, however, hypothermia itself becomes life-threatening. "The patient's body temperature was exactly in the right range," says Dr. Peter Stachon, internist in the intensive care unit of the Department of Internal Medicine at Freiburg University Medical Center.
When Abdul A. was admitted to the hospital in Constance, the doctors there quickly realized that the patient was on the verge of lung failure. They therefore call for support from experts at the Center for Invasive Lung Replacement at Freiburg University Hospital.
If ventilation via the lungs is not possible, ECMO can help
If the patient cannot be ventilated via the lungs, the Freiburg doctors have one last option: extracorporeal membrane oxygenation, or ECMO for short. In this procedure, the blood is enriched with oxygen outside the body, carbon dioxide is removed and then reintroduced into the heart. In Freiburg, at one of the first and largest ECMO centers in Germany, a team of cardiologists, anesthesiologists and cardiotechnicians is available 24 hours a day. Several hundred patients have already been treated by the specially trained team.
The Freiburg doctors are in Constance by helicopter just one hour after being alerted. "The ECMO implantation by Dr. Stachon and myself came at the last minute, the patient could practically no longer be ventilated normally via the lungs," says anaesthetist Dr. Kalbhenn. The risky intervention and oxygen supply were successful. The doctors bring Abdul A. to Freiburg in a specially equipped ECMO mobile from Freiburg University Hospital.
After ten days, the patient can speak again
16 hours after the accident, the doctors finally manage to provide the patient with a normal oxygen supply. Just five days later, they were able to remove the ECMO system and, after a further five days, stop artificial ventilation via the lungs. Thanks in part to the comprehensive work of the intensive care unit nurses, the patient's situation improved rapidly. When Abdul A. wakes up from his coma, he is in a much better condition than expected. Immediately after waking up, he is able to speak, even in German, which is not his native language.
Luck, good condition and optimal care
A few weeks later, he is transferred to a youth facility for rehabilitation. After three months, the patient is almost fully recovered, he is walking, talking to his friends and will soon be allowed to return to his old home. Only his friends report that he speaks a little more slowly than before.
"The patient has benefited from the excellent care provided by the doctors in Constance and from his very good physical condition," says internist Dr. Stachon. And anaesthetist Dr. Kalbhenn adds: "This example shows that ECMO therapy can be worthwhile even in seemingly hopeless situations. But the patient was also very lucky."