Damar Hamlin, the Buffalo Bills safety who had a cardiac arrest during the recent Monday Night Football three days ago, has made substantial improvement according to his doctors at the University of Cincinnati Medical Center.
From the Buffalo Bills website,
Among those improvements include Hamlin being awake and responsive with the ability to move both his hands and feet, while also being able to communicate with his doctors, nurses and family members via writing on a clipboard.
More, Hamlin’s neurological condition and function is intact after suffering cardiac arrest on Monday night.
As of 10:10 am, Jan 6, 2022, the breathing tube has been removed, and Damar was able to talk to his family and had face time with the Bills team.
Damar won the game of life
The first thing that Damar said when he regained consciousness from the medically induced coma was if they won the Bills-Bengals game. “You won the game of life.” his doctors replied.
Why is that such a piece of great news? Consider the low survival rates among those who had an out-of-hospital cardiac arrest.[1]
- Among those living in North America: 7.7%
- Witnessed by a bystander or emergency medical services: 10.5%
- Those who received bystander CPR: 11.3%
Improving Survival
Because of the very low probability of survival, protocols have been made to improve the patient’s chances.
Paramedics, nurses, and doctors follow the Basic Life Support and Acute Cardiac Life Support Protocols. It includes proper chest compressions, the application of a defibrillator to convert a potentially fatal arrhythmia to a normal rhythm, and medications.
Here is what happens when an ambulance is on its way with a cardiac arrest patient. They call the nearest emergency department and tell them what is coming, the vital signs, medicines given, and their expected arrival time.
This is one of the few times that ambulances come with lights and sirens.
When the patient rolls in, a team of doctors, nurses, a stroke neurologist, and an intensivist are already in a special room waiting for the cardiac arrest patient. Even the radiologist is alerted.
The CT scan room is also waiting because if the patient has a stable pulse, a stat CT scan of the head is needed to ensure no bleeding. That is required before a patient is put on therapeutic hypothermia.
Therapeutic hypothermia is when ice and a cooling blanket are applied to the body. The goal is to decrease the patient’s temperature and metabolism to preserve brain tissue.
Central and peripheral intravenous lines are inserted, medication drips are started, and vital signs are continuously monitored.
During the whole period, someone records the time to ensure that standards are met. Events move fast to save brain tissue and heart muscle.
Neurological Significance
The fact that Damar is awake and moving both sides of his hands and feet means that both sides of the cerebral cortex are intact.
Coherent verbal communication means that the centers of the brain responsible for processing information and expressing thoughts are intact.
Overall, these developments indicate a good prognosis. Credit goes to the Bills’ trainers, first responders, specialists, and nurses attending him.
Still, the greatest factor in Damar’s recovery is his physical conditioning and strength.
Ischemic Preconditioning
Ischemic preconditioning (ICP) is where the heart muscles and the brain cells become resistant to the effects of ischemia which is low oxygen in the blood.
Ischemia happens in myocardial infarction and brain strokes and leads to irreversible damage and loss of function if prolonged.
Not many laypeople and doctors are familiar with this because it is usually a topic for physicians taking care of critically ill patients.
ICP develops when the body gets used to situations where the oxygen levels are low in the blood. Murry, Jennings, and Reimer did the initial experiments that proved its existence.[2]
In the beginning, the heart is exposed, and the coronary arteries are experimentally occluded to promote ICP.
Later on, other scientists found that they don’t have to open the chest cavity, but they can have the same ICP effect by applying a pressurized cuff in the limbs, similar to a blood pressure machine. They called it remote ischemic preconditioning.
The decrease in the oxygen levels in the muscle tissue distal to the cuff leads to molecular changes in the muscles and internal organs like the heart, liver, lungs, intestines, brain, and kidneys to make them more resistant to ischemia.[3]
Exercise can also lead to ischemic preconditioning in the brain and improve stroke outcomes.[4]
The lack of oxygen is not the only insult that happens to the brain but also the subsequent reperfusion.
The return of oxygen leads to the formation of reactive oxygen species, the breakdown of the blood-brain barrier, the influx of inflammatory molecules and immune cells, and the release of excitatory amino acids. The result is early death of neurons or apoptosis, brain edema, and bleeding.[6]
Ischemic preconditioning preserves the brain by strengthening the blood-brain barrier, mediating the inflammatory response, promoting angiogenesis, and inhibiting apoptosis.
The figure below gives an idea about the cellular changes in ICP that makes it neuroprotective.
Volume 177, 17 March 2011, Pages 170-176
ICP also protects the heart against the effects of ventricular arrhythmias [5], which is what happens to Damar.
If you have exercised to the point that your muscles “burn,” which means lactic acid build-up, that is what happens in ICP.
NFL players do a lot of weight lifting and endurance training. Those exercises develop ICP.
Most can do the same exercises and benefit from ischemic preconditioning. ICP is just one of the reasons why people who are fit and strong have greater survival chances than anyone else.
Take Away Message
Strength and physical fitness increase your chances against anything life throws you. Know the basics of chest compressions. Look for a Basic Life Support course near you.
In these times of people suddenly dying, it is worthwhile to have the skills. Know how to use the defibrillator. Most schools, work, and public places are required to have one.
Damar was defibrillated and had CPR on the field, which is a significant factor in his survival.
Know that seconds count when someone is in cardiac arrest, and that first responders may not come as immediately as you expect. Damar is lucky to have BLS-trained people around.
The life you save may be someone you love.
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Related:
- What is Ischemic Preconditioning?
- High-Intensity Interval Training can Activate Ischemic Preconditioning.
- Prescriptions that Promote and Pharmaceuticals that Prevent Ischemic Preconditioning
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- Exercise alone can induce autophagy
- Meta-analysis shows exercise improves neuropathy
- Exercise releases myokines from skeletal muscles
- Exercise Can Stop Tumor Growth
- The effects of kettlebell exercises for women 65 and older
- Physical Activity Correlates with Life Span
- Humanin, Longer Life Span, and How to Have More of Both
- Make that Game Winning Shot that at the Buzzer!
- The Benefits of Resistance Training
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- The Good and Faithful Servant
- Effect of Short-Term Exercise on Mortality
- Exercise Guidelines
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- Myokines: An Introduction
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- Exercise and Neurogenesis
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References:
- Yan S, Gan Y, Jiang N, Wang R, Chen Y, Luo Z, Zong Q, Chen S, Lv C. The global survival rate among adult out-of-hospital cardiac arrest patients who received cardiopulmonary resuscitation: a systematic review and meta-analysis. Crit Care. 2020 Feb 22;24(1):61. doi: 10.1186/s13054-020-2773-2. PMID: 32087741; PMCID: PMC7036236.
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C E Murry, R B Jennings, K A Reimer. Preconditioning with ischemia: a delay of lethal cell injury in ischemic myocardium. 1 Nov 1986. Circulation. 1986;74:1124–1136 https://doi.org/10.1161/01.CIR.74.5.1124
- Tapuria N, Kumar Y, Habib MM, Abu Amara M, Seifalian AM, Davidson BR. Remote ischemic preconditioning: a novel protective method from ischemia reperfusion injury–a review. J Surg Res. 2008 Dec;150(2):304-30. doi: 10.1016/j.jss.2007.12.747. Epub 2008 Jan 22. PMID: 19040966.
- Zhu Y, Sun Y, Hu J, Pan Z. Insight Into the Mechanism of Exercise Preconditioning in Ischemic Stroke. Front Pharmacol. 2022 Mar 8;13:866360. Doi: 10.3389/fphar.2022.866360. PMID: 35350755; PMCID: PMC8957886.
- Schwarz ER, Whyte WS, Kloner RA. Ischemic preconditioning. Curr Opin Cardiol. 1997 Sep;12(5):475-81. PMID: 9352175.
- Yang T et al. Brain ischemic preconditioning protects against ischemic injury and preserves the blood-brain barrier via oxidative signaling and Nrf2 activation. Redox Biol. 2018 Jul;17:323-337. doi: 10.1016/j.redox.2018.05.001. Epub 2018 May 6. Erratum in: Redox Biol. 2019 Apr;22:101067. PMID: 29775963; PMCID: PMC6007054.
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