Lack of oxygen when still breathing

February 26, 2011 5:57 PM

Can a heart arrhythmia cause brain damage even if you're still breathing?

A friend of mine is in very dire straits. The official story goes that when he was found on the ground, he was still breathing so nobody performed CPR. He stopped breathing, however, just as the paramedics arrived. It took about 5 minutes of CPR to resuscitate him. He's alive, but the damage to his brain is so severe that he'll never recover. Now they're just waiting for the brain to die enough that his organs will still be viable for transplants after pulling the plug.

None of the doctors can figure out what triggered the event. It wasn't a heart attack and they can't find anything in his brain or lungs that would have caused it, he apparently just dropped. The current best guess is that it was triggered by an arrhythmia.

I'm having trouble dealing with the grief, and I wasn't there when it happened, so maybe that's why I'm questioning the story. But how can a person who's still breathing (supposedly it was strained) sustain so much damage?

Obviously I have zero medical knowledge, so I'm hoping someone here can shed some light on this for me.

posted by hwyengr to health & fitness (10 answers total)

When you breathe, air is taken in to the lungs, where it is picked up by red blood cells in the blood and spread throughout the body.

If something disrupts the flow of fresh oxygenated blood from the lungs, then there the oxygen will be rapidly exhausted, and cells will begin to die.

This is, for example, how choking somebody unconscious works -- if you place enough pressure across certain parts of the neck, fresh oxygenated blood can no longer flow to the brain, and unconsciousness occurs quite rapidly: 8-10 seconds. Brain damage soon follows.
posted by Comrade_robot at 6:11 PM on February 26, 2011

I literally just got out of an EMT re-cert class in which we spent 8 hours discussing this very issue.

Your friend seems to have suffered an incident of Sudden Cardiac Arrest (SCA). Although SCA is most frequently caused by myocardial infarctions (heart attacks), it can happen due to respiratory arrest or arrhythmia as well.

What the bystanders thought was breathing was almost certainly agonal respiration. Agonal respiration is dangerous and tragic because it makes bystanders think that they should not start CPR. This is not true. Anytime someone is unresponsive, you should immediately call 911 and start CPR. If they don't need it, they will let you know soon enough. Compressions = limited blood circulation = averting brain damage. Irreversible brain damage occurs after ~4-6 minutes without oxygen. People are afraid to hurt someone, but nothing is worse than lack of oxygen to the brain.

Your friend didn't stop breathing as the paramedics arrived. They just had the training to recognize that he hadn't been breathing at all.

I'm very sorry for what happened to your friend. An amazing way to honor him would be to encourage better CPR education in his community.

Knowing CPR and the associated skills (using an AED, accessing the 911 system) should be a requirement for citizenship. If anyone reading this has been thinking about taking CPR one day, do it now. Make the (tiny!) time and financial equipment and be ready to save a life. You can dedicate it to hwyengr's friend.
posted by charmcityblues at 6:24 PM on February 26, 2011 [25 favorites]

I am so sorry to hear this. My condolences to you and your friend's family. I want to share my own personal anecdote, to see if it perhaps makes any sense. I am a layperson, so any medical professionals who are reading - please bear with me.

I have had a heart arrhythmia my entire life. It never bothered me, it still doesn't, but I now pay attention to it (I wear a cardiac event monitor) and I am treating it (blood thinners). Why blood thinners for an arrhythmia? Well, back in November, I had an ischemic stroke. My neurologists immediately referred me to both a hematologist and a cardiologist. Evidently, when your heart does not beat normally, the blood does not pump through it entirely, and can end up pooling in one of the ventricles (medical professionals PLEASE bear with me!). That pooled blood becomes a blood clot, which can be knocked loose and travel to your brain, and you can have a stroke. In my case, I also have a mild form of a clotting disorder (antiphsopholipid antibody syndrome, if it matters), which only exacerbated the clotting problem. Maybe this page can explain it better.

After the stroke, which I am still recovering from, it's not like this diagnosis came immediately, like it does on television. This took months to get sorted out and properly named and treated.


Again, I am so sorry for your loss, and I hope maybe my explanation of how my arrhythmia tried to kill my brain can help you on your path of discovering the answers that you seek.
posted by msali at 6:46 PM on February 26, 2011

I am so sorry.

I think charmcityblues has the explanation for why your friend got so much brain damage when they seemed to still be breathing.

And to pile onto mcali's comment, there are all kinds of arrhythmias. Some are completely benign, some are very quickly fatal. They type she describes is probably aortic fibrulation, where the aorta side of the heart beats too quickly and out of rhythm of the ventricular side, and you get the effects she describes, possibly leading to a heart attack. But the major circulation is still going on, so it isn't immediately life-threatening. The other, worse, kind is ventricular fibrulation. That is where blood flow to the body and brain pretty much stops, and can be (always is?) very life threatening.

And then there is just stuff we can't explain. Sometimes the body just decides to quit, and there is nothing to explain or stop it.
posted by gjc at 6:57 PM on February 26, 2011

Hey charmcityblues, this may be a dumb question, but where should one look if they wanted to get certified in CPR?
posted by MaryDellamorte at 7:55 PM on February 26, 2011

I believe gjc means atrial fibrillation rather than aortic fibrillation.
posted by reren at 7:59 PM on February 26, 2011

gjc - You might mean atrial fibrillation.

MaryDellamorte - The Red Cross often has a lot of local classes. If they don't have any convenient to you, call a local hospital's information line (especially if it's a teaching hospital), look at community colleges, or ask your fire department.
posted by skyl1n3 at 8:01 PM on February 26, 2011

MaryDellorte- skyl1n3 is right about the Red Cross, community colleges, hospitals, and the Fire Department / rescue squad. You can also look into the American Heart Association. Many of the above organizations will send an instructor to train a group (workplaces, clubs, etc) for a pretty nominal fee.
posted by charmcityblues at 12:20 AM on February 27, 2011

Christ, I know something looked wrong, but I was tired and couldn't figure out what. Sorry, yes, that's what I meant.
posted by gjc at 5:12 AM on February 27, 2011

I experienced Sudden Cardiac Death due to Ventricular fibrillation about 3 years ago. I was very fortunate that I was at a location where people knew CPR and had an AED on site. CPR was started within minutes, and an AED was used to shock my heart back to a normal rhythm. Since then, I have had no symptoms or episodes related to the event.
(I had a defibrillator implanted in my chest 2 days after the event - just in case - on the recommendation of my doctors).

My doctors said that I was clinically dead before I hit the ground during the event. I had no warning and no history of heart issues. I was 38 years old at the time, and had been working out regularly for the 14 months prior. I was in the best shape of my life.

My doctors said that this same thing could have happened while watching TV in my house. If that were the case, I would not be here now.

These kinds of things happen for no reason and without warning. I am sorry for your loss.
posted by bonofasitch at 12:28 PM on February 28, 2011