Therapeutic hypothermia helps save marathon cardiac arrest victim

Jay Yim, 21, had worked on improving his fitness since age 15. In preparation for this year's Los Angeles Marathon on March 21, the University of Southern California pre-med student had been training with a marathon club and regularly did 10-mile runs on his own.

The day before the race, he had a carbo-loading dinner with his club members. According to his brother Roy, who spoke with him that night, Jay sounded fine and ready to go.

On race day, Roy watched his brother's progress on the marathon website.

"They had a feature that allowed you to monitor a runner as he passed each milepost," Roy said. "The computer estimate said, based on his progress, he'd finish in 3:15."

But as Jay reached mile 18, something went terribly wrong. He grabbed his chest and collapsed onto the road. He'd suffered a cardiac arrest.

In the first in a string of amazing events that would ultimately save his life, Jay happened to fall about 70 yards from Josh Sewell, a motorcycle officer with the Los Angeles Police Department. Sewell immediately moved Jay off the course and began CPR.

"His eyes were rolling back in his head, he had no pulse and was not breathing," Sewell recalled. "He was in full cardiac arrest."

Another amazing event occurred when, somehow, out of the crowd emerged off-duty physician Dr. Charles Chandler, a clinical professor of surgery at UCLA. He and Sewell continued CPR and called for an ambulance.
"After about four to five minutes, we had return of a strong pulse, but he was not spontaneously breathing," Chandler said. "The paramedics arrived, took over CPR, prepared him for transport and I called our ER to give them what information we had. We got Jay loaded onto the ambulance and taken to Ronald Reagan UCLA Medical Center."

At the hospital's emergency department, a team of UCLA emergency physicians and staff quickly went to work to stabilize Jay and begin the investigation into what would cause a 21-year old to experience cardiac arrest.

Heading Jay's care was Dr. Paul Vespa, a professor of neurology and neurosurgery and director of UCLA's Neurointensive Care Unit.

"When he arrived at the medical center, Jay was in a coma and on a ventilator, in very critical condition," Vespa said. "His brain was certainly at risk for permanent injury due to his heart attack, and we had little time to reverse this effect or even assure that he would live."

Vespa decided to use a state-of-the-art procedure known as therapeutic hypothermia on Jay to maximize his chances for recovery.

"This procedure can be lifesaving in cases like Jay's, where the brain and other organs have been deprived of oxygen for a significant amount of time and the patient is at risk of permanent organ damage or death," Vespa said. "It is not widely used because it requires specialized equipment and trained staff, but it is fully approved."

Vespa and his team inserted a catheter into a large vein and began feeding cooling fluid into Jay's body.

"The process works much like a radiator cools an engine," Vespa said. "The machine runs 24/7 and lowers the body temperature to 89.6 degrees. The cooling protects the body's organs until the brain has time to reboot. We kept Jay chilled for approximately 72 hours, at which time he awoke from his coma. Follow-up tests showed he has no permanent damage to his brain or other organs. He should have a perfect recovery."

Jay was moved out of intensive care on March 30 and is expected to be released from the hospital in the next few days to begin rehabilitation, hospital officials said. Doctors are still unsure of what caused his cardiac arrest.

Jay's family has remained with him since his accident, and he has had another frequent visitor.

"I've spent a lot of time in Jay's room, encouraging his family and watching for signs of his recovery," said Sewell, the first person to come to Jay's aid.
The LAPD motorcycle officer spent much of the week following the marathon in Jay's hospital room and spoke with him for more than an hour after he regained consciousness.

"We've bonded, that's for sure," Sewell said. "He's a great guy. I'm just glad I was in the right place at the right time and was able to be a part of this amazing story."

"If there is a lesson here," Vespa said, "it is that more hospitals need to consider implementing therapeutic hypothermia at their institutions. It can save lives."