CPR, Induced Hypothermia Help Save Mt. Sterling Patient After Sudden Cardiac Arrest

LEXINGTON, Ky. (May 28, 2013) - On Feb. 11, Richard Klotz's evening work shift began like any other.  The 57-year-old Mount Sterling resident  took his shift break shortly before 9 p.m. After that Klotz doesn't recall what happened -- but his coworkers do.  As his break was ending, Klotz suffered cardiac arrest and dropped to the floor.

Turns out, Klotz was lucky to be at work when his cardiac arrest happened. Within seconds, his work team sprang into action, grabbing the automated external defibrillator (AED) and performing a constant cycle of CPR/defibrillation until the paramedics arrived. It was the first of several unique medical interventions that helped save Klotz's life.

Pentair, a plant specializing in products used to enclose, protect and cool critical electrical and electronic equipment components located in Mount Sterling, has employees in each area of the plant and on each shift who are trained to be first to respond to emergencies that happen within the facility, according to Barry Hamlin, director of operations at Pentair.

The company annually trains a group of employees on CPR and use of an AED. The group primarily responds to safety issues or work-related injuries, Hamlin said.

"It's kind of like insurance," Hamlin said. "We have it, and we hope we never have to use it."

In his 20 years working in manufacturing plants, Hamlin said he had never had a team respond to an emergency like this one - a personal health issue that happened at work.

"Their response was anything but standard," Hamlin said. "Given the situation and the life-threatening issue that was here, they kept their heads remarkably well."

"Without that trained team of workers, I probably wouldn't have made it," Klotz said. "If my cardiac arrest hadn't happened at work, I wouldn't have had the outcome I did."

Once Mount Sterling paramedics arrived, they stabilized Klotz for transport to UK Chandler Hospital, utilizing a new protocol for cardiac arrest patients — a Lucas device, which applies CPR to a patient automatically. The Lucas device maintained Klotz's heart rate during transport.  

Once he arrived at UK, Klotz underwent yet another novel protocol for cardiac arrest patients -- induced hypothermia. This requires cooling the patient to a temperature of between 32 and 34 degrees Celsius using a cold saline solution administered intravenously.

During the procedure, the patient is given a paralytic to keep the body from shivering in an attempt to re-warm itself. The patient is also placed on a ventilator to help with breathing. An EEG is used to detect any signs of seizure activity.

Klotz was cooled for 24 hours. The only thing he remembers between collapsing and waking up several days later is the feeling of being cold.

"I could sense that I was cold, but I didn't know why," Klotz said.

UK implemented the induced hypothermia protocol after several studies showed improvement in patient outcomes. Over the past two of three years, physicians at the UK HealthCare Gill Heart Institute have routinely used the process, averaging four or five cases each month.

"Based on several studies that have been ongoing since 2003  - around which time induced hypothermia was first described - induced hypothermia results in good neurologic recovery for the patient," said Dr. Paul Anaya, who treated Klotz when he arrived at UK Chandler Hospital. "The procedure has been impressive enough that the American Heart Association guidelines classify it as a class one protocol for patients suffering from out-of-hospital cardiac arrest due to ventricular fibrillation or ventricular tachycardia."

Anaya noted that recent studies have also shown that induced hypothermia benefits the heart as well.

Part of UK's protocol also requires the patient be transported to the heart cath lab where doctors determine what caused the cardiac arrest. If it turns out the cardiac arrest was the result of an infarction and there was a blocked coronary vessel - like in Klotz's case -  the cath lab can find where that blocked occurred and open up the blockage with percutaneous coronary intervention, using angioplasty and stent implantation.

After being cooled for 24 hours, the patient is gradually rewarmed, the paralytic is reversed and sedation medications are tapered off so the patient can wake up. After waking, the patient's neurological function is assessed.

Anaya says that so far, the procedure has worked as expected for Klotz.

"He has done quite well, from both a physical and mental standpoint," Anaya said of Klotz. "He is living with heart failure, but he's still active and can remain high functioning, and hopefully that will continue to improve as we manage his heart failure with medications."

Klotz said he has also made some lifestyle changes of his own since Feb. 11, including changing his eating habits and being more physically active. But first and foremost, he stopped smoking.

"I haven't had a cigarette in three months," Klotz said. "After what happened, that was the easy part."

On May 20, Klotz returned to work, where he was recognized along with the team of employees who helped save his life.

"I told the team of first responders that nothing I could do, say, or give to them would hold a candle to the feeling they have knowing what they have done," Hamlin said.

"I'm very thankful for them," Klotz said.

While Klotz benefitted from a series of unique medical interventions, Anaya emphasized the important of good, early CPR for cardiac arrest patients.

"Mr. Klotz was very lucky that this happened in a workplace where he was surrounded by his coworkers who were able to get an AED on him and follow the recommendations," Anaya said. "That is really the key to survival and to insuring neurologic recovery, aside from just inducing hypothermia. Others aren't so lucky - they may not have bystander CPR for a prolonged period of time. It only takes a few seconds of a lack of oxygen for brain cells to die off."

Anaya added that in most cases, the public becomes the first responder in cases of heart distress.

"CPR is vital to insuring patient survival and neurologic recovery," Anaya said. "Mr. Klotz's situation is a great example of that - employers providing training for their employees. It's also important for every workplace to consider having an AED — In this case, it turned out to be a vital component."

The first response team responsible for helping save Richard Klotz's life included Dustin Clay, Andrew Skriba, Rodney Shepherd, Daries Conn, Wes Harris and Joel Spencer.