Lifesavers
When Eva Klassen suffered a heart attack, she received immediate medical care that saved her lifeBy KEVIN SWEENEY Journal Editor
Article Photos
NEW ULM - Look at her today, and Eva Klassen appears to be the picture of health. She has a bright smile, clear eyes, and an agile mind. She loves to play Scrabble - and usually wins, according to her children.
One would never suspect that six weeks ago Eva suffered a heart attack that nearly killed her. She is alive today, living self-sufficiently and feeling only a little worse for the ordeal, thanks to a fortunate set of circumstances, some well-trained and well-equipped emergency responders and health care professionals who worked together to treat her.
Eva's heart attack hit her suddenly on Saturday, Aug. 24. Her daughter, Larissa Hummer, and son-in-law Don Hummer were visiting from St. Cloud. It had been a fine day, Larissa recalls (Eva has no memory of the event). They had walked around downtown New Ulm and done some window-shopping. It was 11 p.m. The Hummers had made plans to go out that evening with one of Larissa's brothers, but he was delayed and they whiled away the time playing Scrabble with Eva.
Suddenly, said Larissa, Eva looked up, shook her head a couple of times and passed out.
"There was no breathing," said Larissa. "I shook her a little, but she didn't respond. Don got the phone right away and called 9-1-1 and told me to drag her onto the floor. So I did drag her onto the floor. Don made the call and handed me the phone."
Don, who had taken CPR training through his work, started CPR.
"It took about five or 10 seconds for us to realize something was wrong, and the phone was right there," said Don. "It took about five minutes for the ambulance and police to get here."
According to the medical professionals who helped her, those factors were the first keys to Eva's quick recovery. She was not alone when the attack struck her, and the family called 9-1-1 immediately, then started CPR.
"Sometimes people will call other family members first and ask them what to do," said Dr. Dale Bohlke, MD, the emergency room physician who was on duty that night. "The best thing to do is call 9-1-1 right away and get the medical professionals there as quick as possible."
Deb Lentz, an EMT with Allina Medical Transportation, was one of those who arrived at the scene. Eva had no pulse, wasn't breathing on her own, and was in "v-fib," where instead of beating, the heart pulses in an uncoordinated manner.
The responders immediately put Eva in the Lucas device, a piece of equipment that Allina Medical Transportation has had for about a year. It is an automatic CPR device with a plunger powered by compressed air that delivers 100 chest compressions per minute for up to half an hour, or as long as it is needed. It provides proper, consistent CPR for a long time, far longer than trained emergency staff, who have to switch off every two minutes to keep from tiring out. It keeps the all-important blood flowing through the body.
It also leaves the EMTs and paramedics free to do other tasks, like administering medications and performing other procedures.
"They told us it was going to keep her blood flowing, but it's pretty hard to watch," said Don.
"It looks pretty violent," said Larissa.
Lentz, along with paramedics Katy Kaiser and Greg Delo, and EMT Paul Rose, worked on Eva for half an hour, using a defibrillator several times to try to shock her heart back into a normal rhythm, and injecting drugs to help strengthen the heartbeat. But after a half hour of work, Eva still had no pulse and wasn't breathing. The paramedic's protocol at that point is to check with the emergency room doctor for instructions on what else to do, or whether to stop resuscitation efforts.
Bohlke told them it was time to stop CPR, but Lentz said that even as the call was being made, Eva started to respond to treatment. When they stopped the Lucas Device, she did begin to breathe, and her heart started to beat with a more normal rhythm. She was prepped for a quick trip to the emergency room.
While on the way, the ambulance crew started another important procedure, packing Eva in bags of ice to lower her body temperature, slow her metabolism and delay damage to her heart muscles and brain tissue. The cooling process continued at the New Ulm Medical Center emergency room, where she was diagnosed as having a heart attack and prepped for an air ambulance ride to Abbott Northwestern Hospital.
New Ulm Medical Center is part of Allina's Level I cardiac program. People who have certain kinds of heart attacks, caused by blocked heart arteries, have a much better chance of a good recovery if they can be brought to the Abbott Northwestern cardiac catheterization lab. New Ulm, about 200 miles from Abbott Northwestern, is in Zone 2 of the program. The goal is to get the patient's blocked artery opened within two hours of them arriving at the emergency room.
The protocols for this program call for administering the right medications at NUMC - blood thinners to prevent clotting, beta blockers to control the heart beat - and then opening the blocked artery either with medication or angioplasty, which is done at Abbott Northwestern.
When Eva arrived at Abbott Northwestern she was taken immediately to the cardiac catheterization lab, where Dr. Mike Mooney, a cardiologist met her to perform the angioplasty. A catheter was threaded through a vein in her leg to the blocked artery, which was 95 percent blocked, and a stent was placed in the artery to hold it open.
Even with the blood flow restored to the heart, Eva was kept on the cooling protocol to minimize the amount of damage to the brain. She had arrived at Abbott Northwestern at the right temperature for the protocol - 33 degrees centigrade, or about 4 degrees Fahrenheit below the normal 98.6 degrees.
In the cooling process, the body is injected with drugs to paralyze the muscles to prevent shivering, which would warm the body back up. Eva was placed on a respirator, with a tube down her throat, to do her breathing for her.
Larissa said her mother was kept in hypothermic state for 24 hours while the family waited. Doctors warned the family that Eva might not recover fully from the heart attack. She had been without a pulse, on CPR, for 35 minutes. They weren't sure how long the brain had gone without oxygen. If she survived, there was a chance she would not be herself, they were told.
As Eva was brought out of the cooling state, and warmed up, doctors turned off the respirator for short periods to see how well she could breathe.
"They told us that when they pulled the tube out, she might not be able to breathe on her own," said Larissa. "They asked if we wanted them to put the tube back in if that happened, or if we should let her die."
Larissa and her brothers, Wayne and Victor, decided the tube should go back in, that Eva should have another chance to recover.
It turns out Eva didn't need a second chance.
"They pulled out her breathing tube, and five hours later she was sitting in a chair, eating ice cream and talking to us," said Larissa. "The doctors and nurses said this is a miracle, that this sort of thing doesn't happen very often."
Eva was well enough to come home on Sept. 3. Family members stayed with her for a couple of weeks, but she is now doing fine, going to cardiac rehab classes three times a week at New Ulm Medical Center, and feeling good, except for soreness in the chest from the Lucas Device, and numb lips and a little hoarseness from the intubation.
Physically, there was little permanent damage to her heart, and mentally she is the same as ever. She can't remember anything that happened the day of her heart attack or the day before. All she remembers is waking up in the hospital.
Eva feels sympathy for her children, that they had to face the life-and-death decisions in the hospital, and worry what their mother would be like and what her quality of life would be.
She is also surprised that they care so much for her. "The kids and grandkids, they care so much - I'm just a simple grandma," she said
Turning to Don and Larissa, she said, "Thank you both for being my lifesavers."
It's a thank you that she extends as well to the team of EMTs and paramedics, doctors and nurses in New Ulm and at Abbott Northwestern.
