PCMS_Philadelphia_Medicine_Spring2018 - 41

p h i l a m e d s o c  .o rg

By: Bret Marlowe, CPR Ready Project Coordinator, The Health Care Improvement Foundation

He was motionless, collapsed
into the arms of the stranger
behind him. Young, strong, and
healthy in appearance, Todd
Tewksbury had been running
his usual 6-mile route along the
Schuylkill River Trail in Philadelphia from his home in the
Graduate Hospital neighborhood
to Boathouse Row and back. He
was in excellent conditioning
shape, exercising several times a
week. Now, on August 25, 2014,
he helplessly faced the prospect of
death, dependent on bystanders
around him to act in order to save
his life. His heart stopped beating without warning, preventing
the flow of blood and oxygen throughout his body. It was sudden
cardiac arrest.
Dr. Aaron Mendelson, an internal medicine resident at the Hospital
of the University of Pennsylvania, and his wife, Dr. Kristine Schultz,
Chief Resident of Emergency Medicine at Christiana Care Health
System, helped Tewksbury to the ground near the Schuylkill River Park
to assess his medical condition. They at first thought Tewksbury was
experiencing a seizure, but quickly realized he had no pulse, signifying
cardiac arrest. Knowing that the chance of survival decreases 7-10%
for every minute without cardiopulmonary resuscitation (CPR),1
Dr. Mendelson immediately began chest compressions, alternating
with Dr. Schultz to prevent fatigue and ensure high quality CPR.
Within minutes, numerous other medical professionals, who were
exercising nearby, recognized the situation and offered to assist. One
witness dialed 9-1-1 to alert Emergency Medical Services providers,
while another hurried to retrieve the defibrillator located nearby at
Markward Playground.
After eleven minutes of CPR, the witnesses removed Tewksbury's
shirt, applied the defibrillator pads, and administered a shock from

the automated external defibrillator (AED). Tewksbury did not
respond. The AED, which provides audible instructions to guide the
user, advised additional chest compressions, re-evaluated the heart
rhythm, and delivered another shock. Just as emergency personnel
arrived to the scene, Tewksbury's heartbeat returned to normal.
Tewksbury remained at the Hospital of the University of
Pennsylvania for five days. During his stay, he learned his cardiac
arrest was caused by viral myocarditis, an infection that inflamed
his heart muscles, affecting the heart's electrical system, causing
ventricular fibrillation and cardiac arrest. In Tewksbury's case, the
only symptoms he experienced of the viral myocarditis were similar
to a common cold. These minor symptoms masked the severity of
the underlying infection, which unexpectedly posed a great threat
to his life. Fortunately, the immediate actions performed by the
strangers who witnessed Tewksbury's cardiac arrest enabled him to
make a full recovery.
With basic training in hands-only CPR, everyone is capable of
saving a life. The American Heart Association estimates that 70%
of Americans feel helpless to act when confronted with a cardiac
arrest victim.2 Many people are unsure how to respond, afraid of
causing harm, or worried about liability for providing inadequate
CPR. In Pennsylvania, however, good Samaritan laws protect people
that make a good faith effort to perform CPR. In Philadelphia,
the rate of bystander intervention to perform CPR is 15.0 percent,
compared to 39.9 percent nationally.4 Relatedly, the survival rate for
a cardiac arrest victim with a shockable heart rhythm and witnessed
by a bystander in Philadelphia is 15.5 percent,1 significantly lower
than the national rate of 33.9 percent.2 These rates suggest there is
an opportunity to save additional lives in Philadelphia by promoting
awareness through CPR education.
In June 2016, Penn Medicine, Independence Blue Cross, Children's
Hospital of Philadelphia, American Heart Association, Health Care
Improvement Foundation, American Red Cross, CPR/AED Public
Awareness & Training Network, Philadelphia Fire Department,
and the School District of Philadelphia launched CPR Ready.
Continued on page 42
Spring 2018 : Philadelphia Medicine 41


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