January 16, 2019 by Laura Pincus and Patty Shillington
Frozen in Time: Hypothermia Treatment Helps Teen Survive Cardiac Arrest
When Dwayne Powell (pictured above) deftly dribbles a basketball or sketches one of his stunning drawings, mom Tia Burrows feels more than the usual sense of maternal pride. It’s not just his athletic and artistic skill that causes that emotional swell. Dwayne’s very existence is something of a miracle — to both his family and the multidisciplinary team at Baptist Children’s Hospital, who helped bring him back to life.
“He was blessed with a gift,” Ms. Burrows said. “I definitely feel he has a purpose here on earth.” One minute in late September, Dwayne, then 15, was playing basketball in PE at his high school, looking forward to trying out for the varsity team. The next minute, he was sprawled on the gym floor.
Clearly, something serious was going on. His eyes were rolling around. His body was jerking. He was unconscious and gasping for breath.
By the time paramedics arrived, Dwayne was not breathing and had no pulse. An EKG showed his heart was in ventricular fibrillation, a deadly disruption of the heartbeat that causes cardiac arrest. CPR was started, and on the way to Baptist Children’s Hospital, paramedics used a defibrillator twice to shock Dwayne’s heart. When his mother arrived, a team of specialists summoned from the pediatric intensive care unit (PICU) was hovering over her comatose son.
“I froze,” Ms. Burrows recalled. “He had never even been sick before.” Pediatric critical care specialist Ricardo Queiro, M.D., told Ms. Burrows her son’s condition was life-threatening. Ms. Burrows did the only thing she could think to do. “I went to the bathroom, and I began to pray.”
Only some 10 percent of people who suffer cardiac arrest outside a hospital survive, according to the American Heart Association. Dr. Queiro was perplexed and deeply concerned. Dwayne had no apparent medical conditions, though he had been found to have a “harmless arrhythmia” after one minor heart-fluttering episode, Ms. Burrows told Dr. Queiro. Now he was intubated and close to death. Had he hit his head when he fell?
“The neurological exam was terrible: He had no reflexes, no pupillary reaction. He was completely unresponsive,” Dr. Queiro said. “We had no idea what had happened. This is a healthy kid; it could be anything — a drug overdose, a cardiac episode, an infection, meningitis.”
In the PICU, a team of nurses and doctors worked feverishly to correct Dwayne’s dangerous electrolyte and metabolic imbalances, caused by the lengthy cardiac arrest. Within an hour, still unconscious, he was deeply sedated for therapeutic hypothermia.
Typically used for heart attacks and near drownings, therapeutic hypothermia lowers the body’s temperature to between 34 and 36 degrees C (93.2 to 96.8 F), reducing the brain’s need for oxygen in an effort to prevent or limit brain damage. Doctors theorize that the lower body temperature, maintained by a machine that circulates water through sleeves wrapped around the patient, slows metabolism and counteracts the inflammatory process that causes cerebral swelling and kills brain cells.
In the past few years, the PICU team has used hypothermic treatment for critically ill or injured children more than half a dozen times, with good outcomes in every case, Dr. Queiro said. However, hypothermic therapy has side effects. “To have a patient in hypothermia with a cardiac problem is very dangerous,” Dr. Queiro said.
Ms. Burrows and Dwayne’s father, often accompanied by Dwayne’s four siblings, stayed by his bedside at Baptist Children’s Hospital. After two days of hypothermic treatment, Dwayne’s medical team began the slow warming process, uncertain of what to expect. Ms. Burrows was touched by the depth of Dr. Queiro’s concern. “I saw the sincerity and compassion in his eyes. He was really putting his heart in it.” After Dwayne was weaned off the sedatives, he started breathing on his own, but he did not wake up.
The following day, his nurse, Christina Anteen, R.N., who opted to work on her day off to continue caring for Dwayne, noticed that his blood pressure rose when his mom left the room and settled back down when she returned, suggesting awareness. Finally, Dwayne opened his eyes and recognized his mom, but had no memory of what had happened. “He kept saying, ‘Why am I here?’ ” his mother recalled.
In the coming days, Dwayne began to eat, requesting a hamburger. He started playing video games. It was an emotional moment for the PICU staff when Dwayne took a few shaky steps. “They were teary-eyed with joy because nobody knew what the outcome was going to be, and at first it was looking very bad,” Ms. Burrows said.
Imaging tests of Dwayne’s brain were ordered, and the results were amazingly normal. “Basically, his tests were reading as though nothing had happened,” Ms. Burrows said.
Dwayne’s medical episode remains a mystery. Dwayne tested negative for hereditary cardiac disorders, and Baptist Children’s Hospital pediatric cardiologist Jose Pumarino, M.D., and other specialists at Nicklaus Children’s Hospital, were unable to trace the cause of the dangerous arrhythmia. As a preventive measure, a defibrillator was implanted to shock his heart if it ever happens again.
Today, Dwayne, a soft-spoken rising senior in a visual arts magnet program, is moving forward. Focused on his art, he tries not to think too much about what happened. “I’m calmer about it than my mom is,” Dwayne said. “What I’ve learned is that you have to take advantage of life because you never know when stuff like this might happen.”
For Dr. Queiro, the most rewarding moment came at the end of Dwayne’s hospital stay. “This is a feeling you cannot replace — when they leave the ICU and say, ‘Bye, Doctor.’ ”
This article was previously published in Resource Magazine.