Mumbai: The man who 'died' for 40 minutes lives to tell tale

Dr Narayan Gadkar and his team administered non-stop CPR to Srinivas Vishwanath, miraculously bringing him back to life; (Right)Srinivas Vishwanath

Srinivas Vishwanath, 51, had no heartbeat for 40 minutes. Medically, he was as good as gone. With every passing minute that he did not return to life, his wife Viji felt like her heart was about to stop too. And yet, the doctors refused to give up. For 40 minutes, they performed CPR non-stop, until finally it was death that gave up its hold on Srinivas, whose heart fluttered back to life miraculously.

It was nothing less than a miracle for Viji Srinivas as she watched her husband come to life after flatlining for 40 minutes. But what makes Srinivas even more of a medical marvel is that he regained consciousness the very next day, and was safely discharged yesterday, just a week after his near-death experience. There was no lasting damage to his brain or organs despite having no heart beat for close to an hour.

A lot of the credit goes to the doctors, who refused to give up on the 51-year-old patient. Viji recalled, "I could see on the monitor that my husband had no pulse. It was a straight line. It felt like my heart had stopped too. But, thankfully, the doctors didn't give up on him. After 40 minutes of struggle, when I saw the first heartbeat flash on the screen, I couldn't stop my tears."

What happened
Srinivas had no previous history of heart problems, and despite his age, was an avid yoga enthusiast. It was while he was exercising at his Chembur home that he suffered his first heart attack on the night of November 15. He developed chest pain and broke into a sweat. With the help of neighbours and sucurity guards, his wife rushed him to Zen multi-specialty hospital in an auto. His ECG reported that he had had a heart attack due to complete heart block. As soon as he entered the ICU, he collapsed and went into cardiac arrest.

Dr Ashish Soneji activated Code Blue, an emergency protocol when a patient is in cardiopulmonary arrest, requiring a code team to begin immediate resuscitative efforts. CPR is an emergency procedure that combines chest compressions, often with artificial ventilation, in an effort to manually preserve intact brain function until further measures are taken to restore spontaneous blood circulation and breathing in a person who is in cardiac arrest. This is done in combination with defibrillation, which involves giving an electrical jolt to the heart in a bid to jump-start it.

Normally, cardiopulmonary resuscitation or CPR is administered for a maximum of 20 to 30 minutes. When there is no heart beat beyond that, there is a huge risk of brain death due to lack of oxygen supply.

"His heart had stopped working, there was with no pulse. But we kept giving him CPR for blood circulation, to keep the organs alive," said Dr Narayan Gadkar, intervention cardiologist at the hospital, who led the CPR efforts. The doctors decided to keep going even though he had flatlined because they noticed sudden spikes of about 10 to 12 bpm in his heart rate. Gadkar added, "There was a time when we also lost hope and I came out to inform his family that the chances of his survival were low. But we kept going with CPR, and he finally responded after 40 minutes, when the heart started beating again."

The entire episode lasted an hour and 10 minutes from the first attack at home. The doctors waited another 30 minutes until Srinivas's condition stabilised. His condition was complicated by the presence of head injury and gastrointestinal bleed. Dr Roy Patankar and his team had quickly performed an endoscopy and sutured the scalp, after ruling out brain hemorrhage. Following this, Dr Gadkar wheeled him into the operation theatre to implant a temporary pacemaker and perform life-saving angioplasty.

The doctor said, "Normally, in such cases, where patients revive after more than 30 minutes of no heart rate, many either die or remain on ventilation. But in this case, the patient regained consciousness the next day and was discharged in a week, which is actually a miracle."

Rarest of rare cases
Dr N O Bansal, professor and head of the Cardiology Department at Grant Medical College and Sir JJ Group of Hospitals, said, "Generally, we provide CPR for 20 to a maximum of 30 minutes. In this case, there might have been sudden spikes in the heartbeat, so they continued for 40 minutes, which is extremely rare. There is also the risk of brain damage after such a long gap, and the lack of oxygen flow can also cause brain death. The fact that the patient recovered completely without any damage is rare indeed, and the doctors' efforts must be appreciated."

Compression: Put the person on his or her back on a firm surface, kneel next to their shoulders. Place the heel of one hand over the centre of the person's chest. Place your other hand on top of the first hand. Keep your elbows straight and position your shoulders directly above your hands.

Use your upper body weight (not just your arms) as you push straight down on (compress) the chest at least 2 inches but not more than 2.4 inches. Push hard at a rate of 100 to 120 compressions a minute.

If you haven't been trained in CPR, continue chest compressions until there are signs of movement or until emergency medical personnel take over. If you have been trained in CPR, go on to the next step.

Airway: If you're trained in CPR and you've performed 30 chest compressions, open the person's airway using the head-tilt, chin-lift maneuver. Put your palm on the person's forehead and gently tilt the head back. Then with the other hand, gently lift the chin forward to open the airway.

Breathing: Rescue breathing can be mouth-to-mouth breathing or mouth-to-nose breathing if the mouth is seriously injured or can't be opened.

With the airway open (using the head-tilt, chin-lift maneuver), pinch the nostrils shut for mouth-to-mouth breathing and cover the person's mouth with yours, making a seal. Prepare to give two rescue breaths. Give the first rescue breath - lasting one second - and watch to see if the chest rises. If it does rise, give the second breath. If the chest doesn't rise, repeat the head-tilt, chin-lift maneuver and then give the second breath. Thirty chest compressions followed by two rescue breaths is considered one cycle. Be careful not to provide too many breaths or to breathe with too much force. Resume chest compressions to restore circulation.

Shock: As soon as an automated external defibrillator (AED) is available, apply it and follow the instructions. Administer one shock, then resume CPR for two more minutes before administering a second shock. If you're not trained to use an AED, a 911 or other emergency medical operator may be able to guide you in its use. If an AED isn't available, continue CPR until there are signs of movement or emergency medical personnel take over.

20 No. of mins CPR is provided usually
40 No. of mins CPR was provided to patient
70 No. of mins the cardiac episode lasted

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