The same cold weather physiology that slowly saps life, kept Marc Medina alive, when doctors performed a new procedure at the Hospital of St. Raphael.
Wednesday Medina was back at work — newly engaged to be married.
Medina, 31, is apparently the first patient in Connecticut to receive hypothermic treatment following a cardiac arrest.
An undiagnosed cardiac disorder sent his normal rhythm into chaos. His heart quivered and stopped.
Physicians at the Hospital of Saint Raphael in New Haven cooled Medina sufficiently to keep his brain and other vital organs preserved, stemming the body’s natural tendency to create chemicals that destroy brain cells and hasten death.
The doctors at St. Raphael’s presciently wrote a protocol for the new procedure just days before Medina collapsed.
Medina, who lives in Milford and works as a corrections officer at McDougal-Walker Correctional Institution in Suffield, was enjoying a sunny autumn day with his girlfriend, Jillian Trez. (They’re pictured at the top of the story.)
“We went hiking on Sleeping Giant for about two hours. I was feeling great. We picked pumpkins,” Medina said.
“It was a beautiful day. We got home to walk the dogs,” he said.
Trez, 28, rounded up the couple’s two Yorkshire terriers, and then heard a funny noise. A muffled crash.
“The next thing I knew I woke up in the hospital,” he said.
“I found him in the bathroom. I tapped him on the face. I had no idea that he wasn’t breathing,” Trez said.
Medina started to look worse. Starved of oxygen, his face began to turn blue. “I called 911 and told him to ‘Hang in there,’” she said. In a few minutes — six or seven, records show — she heard approaching sirens.
Dr. Roger Elias, a pulmonologist and director of St. Raphael’s Intensive Care Unit, said that as a rule, brain cells begin to die after 10 minutes without oxygen.
Milford first responders arrived and immediately began cardiopulmonary resuscitation, saving Medina’s life. He was quickly taken to Milford Hospital, where he was stabilized, and then rushed to St. Raphael’s.
Elias and Dr. Mark A. Marieb, a cardiologist, were waiting for Medina. Marieb suggested induced hypothermia and Elias readily agreed. “WIth hypothermia there is a higher chance of full recovery,” he said.
The idea of induced hypothermia, or intentionally lowering body temperature, is not new.
Doctors tried it in the 1950s and 1960s without success. Cooling someone until his body begins to shut down and then bringing him back to life is complicated.
“Once the patient’s temperature goes down, the metabolism goes down,” Elias said. This, in turn, may reduce the inflammation that often accompanies brain injuries, Elias said.
The temperature in the body’s core must be dropped to 89 to 93 degrees. That does not sound terribly cold compared to the “normal” 98.6 degrees, but it is significantly lower than the core’s normal temperature.
Medina was wrapped in blankets embedded with plastic tubing.
Cold water was then pumped through the tubes, drawing heat away from the patient.
“He was in a stable rhythm, but he was unconscious and intubated. He had good blood pressure and heart rate,” Elias said.
One of the complexities of the procedure is the number of signs that must be monitored, he said. “It’s an uncomfortable and unnatural situation.”
The body shivers to generate heat. That’s opposite of what the doctors are trying to do, so the patient is sedated and given paralytic drugs.
Blood pressure increases in response to cold, as the body tries to warm the extremities.
The pressure must be kept elevated to ensure that blood continues to reach the brain, Elias said. Too much pressure could cause other serious problems.At the same time the levels of electrolytes, the elemental ions that maintain normal cell function, become unbalanced. Clotting factors also settle out, raising the potential problem of hemorrhage Elias said.
As his body chilled, Medina’s heart rate dropped to 30 beats a minute.
Medina was kept cold for 24 hours.
Medina had arrived at the hospital at about 6:30. Now it was close to midnight.
Medina’s and Trez’s parents were there, along with Jillian’s sister and her boyfriend.
Together they waited. When he awoke Marc might be normal, might have extensive brain damage, or be trapped in some condition in between.
“They said he could be fine, or mildly brain damaged, or severely brain damaged,” Jillian said.
“I sat there wondering ‘Will he be able to recognize me?’ ‘Will he be able to move his arm?’” she said.
Warming Medina took eight long hours.
When Medina did wake up he was confused and disoriented.
“I kept asking, ‘What happened? Why am I here,’” he said.
Jillian told him that he had suffered a full cardiac arrest, but not a heart attack. “I don’t know what they told me,” he said.
“I knew that his long term memory was good, but not his short-term,” Trez said. “It was like talking to a kid. Reassuring him was hard. He had to trust us. We had to keep telling him we were there to help him over and over and over again,” she said.
Marc came around and is now back to normal. He has a pacemaker and defibrillator to make sure that his heart maintains a healthy rhythm.
“Everyone was excited. He made a full recovery,” Elias said.
“I’m kind of sad that she had to go through all of that,” Medina said of Trez. “If she hadn’t been there, I would have been done.”
“It still hasn’t sunk in. You’re kind of numb,” Trez said. “It’s still kind of like, ‘This really happened?’”
Medina was scheduled to be back at work this week and the couple has become engaged.
They’ve already made it past “through sickness and health” and even sidestepped a parting by death.