VOLUME 32, ISSUE 2

Interview with John C. Arnold, MD DABA, Anesthesiologist at Valiant Anesthesia Associates and Medical Director of Texas Health Arlington Surgery Center, and Kyle Riggs, who both happened to be shopping in the same grocery store.

Roman philosopher Seneca is credited with the quote “Luck is what happens when preparation meets opportunity.” This was illustrated well a few months ago when, in a Fort Worth area grocery store, a 36 year old, otherwise healthy customer (Kyle Riggs) suffered chest pain followed quickly by cardiac arrest. Quick action by other customers led to early and aggressive treatment. One of those responders was anesthesiologist John Arnold, M.D., who happened to be shopping in the store that day. Once Dr. Arnold and others came to Kyle’s aid, the actions of all involved led to a rare full recovery from an outside of the hospital cardiac arrest. He received cardiopulmonary resuscitation almost immediately which was sustained until firefighters arrived with an automated external defibrillator (AED). Quick transport to the hospital (Texas Health Harris Methodist Hospital-Fort Worth) where hypothermic protocols were initiated and a cardiac stent placed into a 95% occluded left anterior descending artery had the desired effect of a full functional recovery of cardiac and brain function.

Medical literature reports that the survival of patients who experience out of the hospital cardiac arrest and are successfully discharged is extremely low. The journal Resuscitation reports that the percentage of out of hospital cardiac arrests surviving to discharge is 7.6% in Europe, 6.8% in North America, 3.0% in Asia, and 9.7% in Australia.(1) These numbers do not take into account the severe sequelae that many of these patients suffer from related to their cardiac arrest that can have profoundly negative impacts on their quality of life. The bleak survival numbers are what make this story so profound. Kyle Riggs was able to survive his cardiac arrest and has made a full neurologic recovery. Earlier this year, I had the opportunity to ask Kyle and Dr. Arnold some questions about the event so that I might share this remarkable human interest story with our readers.

RKM: Dr. Arnold, did you ever contemplate that you would be responding to a medical emergency when you arrived at the store that day?

Dr. Arnold: My family always teases me because I am always evaluating people in the public looking to see who might be sick. Normally, I am very aware of my surroundings. But that day, I was just running a quick errand and not expecting any excitement.

RKM: Dr. Arnold, is this the first time you have ever had to respond to an out of hospital cardiac arrest?

Dr. Arnold: Years ago, when I was an intern, I was at the State Fair in Dallas, right next to where “Big Tex” is located. A guy had collapsed there and I started compressions. He looked very sick and did not have a pulse when he was loaded into the ambulance. I don’t know how that turned out, but likely he did not do well. I have also had two colleagues at work experience separate severe health issues that required my intervention. Both of these events have occurred since the incident with Kyle. Since things frequently occur in threes, I hope I am done for a while.

RKM: Dr. Arnold, Kyle was very lucky that you were in the grocery store at that moment. How did you find out that he needed help?

Dr. Arnold: I believe in God and I believe that He puts us in positions to assist others. I am so thankful that I could be a part of helping Kyle through this. As soon as I walked in, I was waved over to the pharmacy area because the store manager recognized me from my previous visits and knew that I was a doctor.

RKM: When you arrived to where he was, what did you find?

Dr. Arnold: He was face down after collapsing and his skin was a dusky blue. He looked young for his age, so I initially thought he might be a college student. I wasn’t initially sure if it might be some sort of drug or alcohol related incident. After a brief moment, I realized it was likely a cardiac arrest.

RKM: What actions did you take after assessing the situation? For approximately how long was Kyle without a pulse?

Dr. Arnold: We rolled him onto his back and started chest compressions and I helped support his airway. I asked for someone to call 911 and asked for an AED, which, unfortunately, was not available in the store.

RKM: Describe how responding to a cardiac arrest in the operating room is different from responding to a cardiac arrest in the grocery store. What did you find to be frustrating?

Dr. Arnold: In the operating room, we are fully equipped to respond and it is generally much more of a complex issue with a bigger differential diagnosis. We are always prepared for the possible bad outcomes, so our senses are frequently on high alert. In the field, it can catch you by surprise. In most situations, you have to think cardiac arrhythmia first. The frustrating part was not having a defibrillator on hand, considering it is such a large grocery store with so many customers. We were lucky, however, that the fire station was right across the street and the response time was only about three minutes.

RKM: How do you think your training as an anesthesiologist uniquely prepared you for managing this situation?

Dr. Arnold: It made all of the difference in the world. Airway management and the management of cardiopulmonary resuscitation (CPR) were both things that I was very comfortable with from my residency, fellowship, and clinical practice. I had the experience and knowledge to know he needed defibrillation as soon as possible, so I believe that this was able to shorten the response time.

RKM: In retrospect, is there anything you have learned from this experience that you will carry forward if you are ever faced with this again? Is there anything you would do differently?

Dr. Arnold: I will always be prepared. I believe that preparation is important. As a resident, I reviewed the advanced cardiac life support (ACLS) card before each call as a “good luck charm” because someone told me once that, if you review ACLS prior to the call, you won’t have to do any codes. In addition, I had just renewed my ACLS certification. In hindsight, I wish I would have stuck around afterwards to communicate better with Kyle’s wife, who was really upset. I encouraged her to follow the ambulance, so there was really not much time for us to talk, other than a very brief introduction.

RKM: In directing lay persons on how to assist in the resuscitation, what did you find to be surprising?

Dr. Arnold: Initially, nobody wanted to touch him because they were afraid he may have a c-spine injury. The person that assisted with chest compressions seemed to know exactly what he was doing, so I was very happy to have him there. His compressions were very effective and I was impressed by his skills as a non-medical person. That allowed me to be able to assist with jaw thrust, perform pulse checks, and do an overall assessment. It also allowed me the ability to give report to the firefighters and to assist with placing the AED pads and shorten the time to shock delivery once the firefighters arrived. His abilities allowed me to be free to run the code. Once the shock from the AED was delivered, his heart rhythm quickly returned to normal sinus. The guy who had been performing such good chest compressions looked at me and said, “Is he gonna die?!?” I barely recall my response, but I was reminded of it after the fact. I just looked at him and said, “Nope! Not today!!”

RKM: That is a perfect response. Kyle, it sounds as though you had some warning signs throughout the day that you brushed off as not serious. Can you tell us about those?

Kyle: Yes, I had some pretty serious chest pain that day. It seemed to be specific to my heart area, and not the entire chest/arm pain that I’ve always heard about related to a heart attack. However, I just assumed it was heat or dehydration related, since I had been working outside all day in 100+ degree weather, and since I was a healthy, 36 year-old with no signs or concerns of heart issues.

RKM: Your wife, Jennifer, did a great job of recording the events for you so that you could know what happened while you were unconscious or sedated. She said that she had sent you into the store to get aspirin because of your symptoms and, while you were gone, was thinking that she should just take you to the hospital to get checked. After a few minutes, you never emerged from the store and she soon saw fire trucks arriving from a nearby fire station, and she stated that she had a sense of dread that they were there for you. How concerned were both of you about your symptoms prior to going into the store?

Kyle: I was slightly concerned, since it was obviously something that was out of the norm, but I’m also the type who tends to think it couldn’t have been something too serious, since my family has always been healthy and we tend to avoid medical care, if at all possible. My wife was much more concerned, though, as that’s her nature.

RKM: Do you think that your young age had something to do with your dismissal of the symptoms earlier in the day?

Kyle: No doubt. I just didn’t think something that serious could happen to someone of my age and good health.

RKM: What was the last thing you recall prior to your cardiac arrest?

Kyle: Nothing specific, really. I remember working on our investment property with my brother, and having some pretty serious pain throughout the day, but I don’t remember much outside of that. That day is mostly a blur.

RKM: Kyle, can you briefly summarize your recovery? Have you experienced a full cognitive recovery or have you noted some difficulties?

Kyle: My recovery was incredible. I was handling some work calls and emails a few days after getting home, I flew through seven weeks of cardiac rehab, and have just had a completely successful recovery. I feel truly blessed.

RKM: I heard that you and Dr. Arnold and another first responder have stayed in touch afterwards. Can you elaborate on how that occurred?

Kyle: Since we are all in the same neighborhood (Cliff McMurry is the other individual who did CPR), we discovered that we had many mutual acquaintances. We’ve all since stayed in contact and have become close friends. It’s been an incredible experience to get to know those fine gentlemen. I think it’s been great for all of us to get to be involved in each other’s lives.

Dr. Arnold: I actually went to the firefighters who transported him to the hospital to try and find his name. Despite the fact that they remembered me from the event, their policy on patient privacy prevented them from disclosing his information. A few weeks after the event, through a friend of a friend of a friend on Facebook, someone made the connection and put us in touch with each other. We got in contact and decided to meet. I decided to bring Kyle a special gift. It was a t-shirt that simply said, “Nope! Not today!” Since that time, our families have become very close and we realized that we had all probably seen each other numerous times as we lived in the same neighborhood, attended the same wedding, and sat a few rows from each other at sporting events.

RKM: Kyle, you have told me that you feel it is important for others to hear your story. What do you think is the importance of your story?

Kyle: My main takeaway is that there’s nothing more important than knowing CPR, and not being afraid to get involved to help someone. I’m not here today if Cliff and Dr. Arnold didn’t do what they did, so it’s my family’s goal to raise as much awareness as possible to stress the importance of CPR. Also, I want others to know that you should get routine heart checkups. As is evident by my case, you just never know unless you get checked.

RKM: Dr. Arnold, what do you think other physicians and health care providers should learn from Kyle’s story?

Dr. Arnold: Be prepared and never give up. ACLS certification is important and you may be the only doctor around, so you may be called to do a quick assessment in a crisis. Young people are resilient, so don’t give up. Also, don’t be proud. Ask for help and utilize all resources.

RKM: The out of hospital cardiac arrest survival rate has been reported to be pretty dismal. To what do you attribute this seemingly miraculous recovery? What are the factors that you believe played a role in the successful resuscitation and recovery for Kyle?

Dr. Arnold: Quick response. Acting fast with chest compressions was the key. The quick response from the firefighters was important as well.

RKM: What about you, Kyle?

Kyle: Again, it all starts with CPR. I’m not here without that. After that, I attribute a lot of my recovery to the wonderful care I was given at Harris Methodist, as well as my health/physical condition. We were told multiple times throughout my hospital stay that a big part of the reason I bounced back so quickly was because I was in previously good shape.

RKM: Dr. Arnold, do you have any advice to other medical professionals who may be called into action in a situation such as this?

Dr. Arnold: Stay current in your mind and think through things before you are put in that situation. It helps to always consider what you would do in a variety of situations.

RKM: I want to thank you both so much for sharing this incredible story with us. I am hopeful that this will inspire others to mentally prepare for the possibility of needing to render aid in the out of hospital setting. Responding to emergencies outside of the hospital can be quite intimidating, as we find ourselves without all of the needed resources to assist, such as medications and medical equipment. I hope that this will cause us all to pause and consider how we would respond in these emergencies. Our vigilance that we pride ourselves on in the hospital setting can also be of great assistance to those in need in other settings, as has been demonstrated in the situations of Kyle and Dr. Arnold. It is my hope that, like Dr. Arnold, we can all be well prepared when faced with opportunity.

1-Berdowski J, Berg RA, Tijssen JGP, Koster RW. Global incidences of out-of-hospital cardiac arrest and survival rates: systematic review of 67 prospective studies. Resuscitation 2010; 81: 1479–87