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June 10, 2010

Importance of AEDs hits home — twice

AED signThe importance of cardiopulmonary resuscitation training and the availability of automated external defibrillators (AEDs) has been demonstrated dramatically on the Pittsburgh campus in the past two months.

Two people who stopped breathing in separate incidents were saved through the speedy actions of bystanders and emergency responders. Sociology lecturer Mike Epitropoulos collapsed while on a treadmill at the University Club April 15; a woman identified by witnesses as a campus Sodexo employee was stricken June 2 in the Eureka Building.

Pitt police officer Dave Nanz is among those being credited as a lifesaver: By coincidence, he responded to both calls.

Nanz, a 13-year veteran of the University police force and Pitt’s canine officer (see Jan. 10, 2008, University Times) is on call 24 hours a day with his four-legged partner, explosives dog Officer Riggs, but he also covers a regular shift and answers ordinary police calls when Riggs’s special skills aren’t being put to use.

Pitt police are trained in CPR and carry AEDs on all calls for medical assistance, Nanz said. However, Chief Timothy Delaney noted that most people who are trained aren’t called upon to use those skills. All Pitt police cars carry portable AEDs, but the chief said they had not been used prior to these incidents.

Delaney acknowledged it was highly unusual to have two such emergencies on campus in the span of less than two months.

According to the American Heart Association, in cases of cardiac arrest, CPR and AEDs increase a victim’s chances for survival. Although no nationwide statistics exist, early CPR and defibrillation within the first 3-5 minutes after a person collapses, accompanied by early advanced care, can result in long-term survival rates greater than 50 percent. But, according to the AHA, unless CPR and defibrillation are begun within minutes of collapse, few resuscitation attempts are successful. As a rule of thumb, survival is reduced by 10 percent for each minute defibrillation is delayed.

Both victims initially were taken to UPMC Presbyterian. Epitropoulos missed only two days of classes following his emergency; a UPMC spokeswoman had no information on the woman’s condition and a Sodexo co-worker, citing health privacy law, would say only that the employee was not available to comment.

Epitropoulos, 43, isn’t the classic cardiac arrest victim. He has polycythemia vera, a chronic blood condition in which bone marrow overproduces blood cells. The excess of red blood cells thickens the blood. Epitropoulos said he had bypass surgery in 2004 to treat a blocked artery but has been healthy since.

His regular exercise routine had been running up to 5 miles on the treadmill four days a week. Epitropoulos said he was nearing the end of his run on a Wednesday afternoon. He recalls cursing when his iPod fell off the treadmill. He bent to retrieve it.

“Then I don’t remember.”

Fortunately, anesthesiology professor Joseph Quinlan was exercising nearby and Health Sciences Library System clinical librarian Michele Klein Fedyshin, who earned her RN last October, had just walked out of the locker room.

She found Epitropoulos on the ground with gym staff shaking him and asking whether he was okay. He was non-responsive and his lips were turning blue. “I found no pulse, no respiration, nothing,” she said. She and Quinlan began CPR and someone ran for an AED. When Fedyshin applied the sensors, the AED likewise found no pulse and delivered three shocks, she said.

Epitropoulos began breathing but had no pulse, she said, adding that she and Quinlan continued CPR until Pitt police arrived.

Officer Nanz said he received a call for a man down on a treadmill at the University Club and envisioned it was someone who had fallen. “I was surprised to see bystanders performing CPR on him,” Nanz said. He used the AED from his cruiser and tended to Epitropoulos until city police and medics arrived.

In the hospital, Epitropoulos was kept sedated and in a cooling blanket for several days. “I didn’t know anything until Saturday,” he said. “I felt pretty okay. I didn’t know what happened,” he said. Doctors tested his cognitive function as well as his cardiac function and found no damage.

Because his blood condition puts him at risk for future incidents, he left the hospital with a defibrillator implanted in his chest.

Although he technically was dead, “I feel no different now than before,” he said. “The bypass was a bigger thing, a more difficult rehab. But this was death. It’s hard to understand. It’s a lot to think about. The dead part’s not the worst because I don’t remember it,” he said.

“My ribs paid for it,” thanks to the strong chest compressions he received during CPR, he said. “It’s the only thing that hurt.”

Because he had no heart damage, within two weeks he began cardiac rehab that includes walking, running and rowing three days a week at UPMC Shadyside. Epitropoulos said he’s been given the okay to work out on his own on his off days, but University Club staffers are insisting on a note from his doctor first. “I’ll be back there quick enough,” he said.

Although some are commending Nanz as a hero, he’s not comfortable wearing the label.

He said he’d never revived anyone who was in cardiac arrest before. In Epitropoulos’s case, “I knew the results when the medics showed up and said the man had a pulse and we could stop CPR,” Nanz said. In the second situation at the Eureka building, he was better prepared. The call indicated an unresponsive woman. “I pretty much figured she was unconscious and would need CPR,” he said. He as well as firefighters and medics joined in reviving her. “She had a heartbeat by the time she got into the ambulance,” Nanz said.

“It’s just fortunate we were able to have positive outcomes in both these experiences,” he said. “It’s rare to save someone with CPR and even more so to have two such situations, two positives in a row.”

Likewise, Fedyshin said, “I was so glad that I was there and that we were able to react appropriately and do what we were able to do.” She said Epitropoulos is fortunate that people nearby knew what to do. “He had people who knew how to ventilate him. We jumped right on it and were able to administer CPR. That and the AED were crucial,” she said.

Fedyshin said she has kept up her CPR training for many years, having been a lifeguard and water safety instructor. As a new nurse, “It was all fresh,” she said. In addition, in her work she participates in training at the Peter M. Winter Institute of Simulation Education and Research (WISER) Center  — on mannequins programmed to simulate cardiac arrest.

“Practice was immensely helpful,” she said. “We proceeded pretty methodically. It adds stability and balance when you have the checklist and technique to use. It gives you focus.”

CPR training is readily available, she said. “AEDs are the critical piece, but it helps to have people trained in CPR around.”

Epitropoulos has been contacting the individuals involved to thank them for saving his life.

His first and most emotional call was to Nanz. “It’s weird talking to the people who actually saved your life. How do you talk to them?”

He said before he got choked up and emotional, he had to jibe Nanz about the pain in his ribs, “but I thanked him. That’s how [CPR] needs to be done.”

He has spoken with Fedyshin and plans to contact Quinlan as well. “What do you say? They were at the gym. They did what they needed to do,” he said.

Fedyshin, who works out in the gym a couple of times a week, said she didn’t know Epitropoulos prior to helping rescue him. The two have spoken but she has yet to meet him in person. “It was amazing to talk with him on the phone. When I met him, he was dead,” she said, joking that she might not recognize him today.

Not surprisingly, Epitropoulos is sold on the idea of having publicly available AEDs. “We need them. We don’t have enough of them.”

Exercising at a club whose members are affiliated with one of the nation’s top medical schools has its advantages, he said, quipping that his rescue has helped boost the membership at the University Club. Because of the caliber of his gym companions, “a couple of people from my medical team decided to join,” he said.

—Kimberly K. Barlow

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