Damar Hamlin - Now (1/11/2023) discharged from Buf Gen & “recovering at home”

[Ethan in Cleveland]

30 minutes ago, RiotAct said:

awesome sign.  As others have mentioned, the fact that he’s a young professional athlete likely makes his road to recovery a lot easier than, say, a 70 year old’s (notwithstanding playing pro sports is why he’s in this situation in the first place…)

Not really. I know that is an easy assumption to make but brain reperfusion and recovery is mostly determined by total time of the arrest and the adequacy of the CPR, and sadly just luck.   

[GaryPinC]

2 hours ago, Kmart128 said:

My question is if it's true his heart stopped at hospital does that indicate that the hit to the chest didnt necessarily cause the heart issue. From my understanding based off what these doctors are saying is a hit to the chest causes the heart electrical sustem to get out of whack. But if its started again with CPR or AED then it should go back to normal and its just a case of how much damage is caused. If his heart stopped again does that mean there is something underlying or could the first cardiac arrest cause multiple?

I work in cardiac research where we study rearrest and also reperfusion injury primarily to the brain.  I am not a doctor or health professional, just a bench researcher.  But a big part of our work involves animal models with clinical electrophysiologists and ER docs.

I can offer some perspectives and hopefully will keep it from getting into the scientific weeds.

 

The short answer to your question is the first cardiac arrest could cause multiple arrests, but it's truly an individual response.  The second the heart stops, in some corners of the circulatory system blood begins to clot immediately raising the risk of stroke and a massive inflammatory reaction is initiated.  The body quickly becomes hypoxic with reactive oxygen species (ROS) which damage DNA, RNA, proteins and can cause cell death.

 

In Hamlin's case, one could easily surmise he quickly became hypoxic given the physical exertion of the game.  

 

Also keep in mind that just because you restore sinus (normal) rhythm doesn't mean the heart is beating normally.  What usually happens post-arrest is despite the normal rhythm, electrical contraction(depolarization/QRS complex) is incrementally slowed(widened QRS complex) and relaxation (repolarization/T-wave) is usually a mess (ST elevation, elongated/elevated T-wave).  At this point the patient can be very susceptible to rearrest.  And this period can be as short as a couple minutes to nearly an hour in my animal model experiences.

 

Anyways, from my perspective, putting an arrest survivor under therapeutic hypothermia is about mitigating and controlling the inflammatory damage while also slowing the metabolic processes and the heart to hopefully prevent more arrests.

 

In terms of the brain, the inflammatory reaction compromises the blood/brain barrier, allowing blood and inflammatory cells into the brain to kill brain cells.  The first 24 hours are critical as the damage and cell death will evolve over the next couple of subsequent days.  Again, therapeutic hypothermia is crucial in arresting and limiting this damage.

 

I was in disbelief that the ambulance waited even 1 minute to allow Damar's mother to ride along.  Getting him to the medical center and started cooling is critical.  I just thank God he didn't rearrest in that ambulance with his mom right there.

[Ethan in Cleveland]

30 minutes ago, Beck Water said:

 

 

Hi Herc,

I had that phrase in quotes because it was used in the post to which I was responding to.  I think the person in question was thinking of weaning off the vent, but unsure what exactly they meant and probably should have asked not quoted.

 

IF (and we don't know this) Damar Hamlin has been placed in a post-cardiac arrest hypothermia protocol, information on the interwebs from two major medical centers seems to differ from your corrections in terms of the protocol they use.

 

Johns Hopkins has a writeup explaining the treatment for patients and family:

https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/therapeutic-hypothermia-after-cardiac-arrest  (which someone cited upthread) says the following:

 

University of Pennsylvania has a protocol online:

https://www.med.upenn.edu/resuscitation/hypothermia/assets/user-content/documents/TherapeuticHypothermiaProtocolforCardiacArrest.pdf

 

This protocol also mentions that the patient is maintained on sedation while being cooled, maintained in hypothermia, and rewarmed (Phase 1 2 and 3).  They use the term "sedation vacation" as you use "spontaneous awakening trial":

 

Last, a study in the New England Journal of Medicine comparing hypothermia to normothermia calls into question whether hypothermia has a benefit and there are several similar studies:

(possible benefit for out of hospital arrest with no bystander CPR, but this doesn't apply to Hamlin) and reiterates that the protocol is not used if the patient was conscious and responding to commands after pulse was restored (which in one interview, Hamlin's friend and marketing manager said he was at one point, prior to sedation and intubation). 

 

Again, the hypothermia protocol may not have been used, but if it was, the protocols and patient reference from two major medical centers appear to differ from your information/the protocol with which you're familiar, to say that gradual rewarming IS part of the protocol, and sedation vacations/spontaneous breathing trials are not used during hypothermia treatment.

Good post. The hypothermia protocol has changed over the years and there is no standard protocol used.  It sometime depends on how long the cardiac arrest is and what if any activity the patient is showing immediately at ROSC.  

You are correct a weaning trial would not be tried until the patient is fully rewarmed.  And some centers do a gradual rewarming while others simply remove the cooling device and allow the patient's temperature to rise naturally.  The reality of it is the patients temp is hard to control unless you are using an IV cooling catheter which has mostly fallen out of favor as most institutions are using non-invasive cooling means (ice bags/cooling blankets) as they are cheaper and easier to administer.

[uticaclub]

20 minutes ago, Mr. WEO said:

Very few jobs  have the majority of full time employees retire as millionaires and still provide them with long term free healthcare/insurance. 

It's a Mina Kimes interview with Foxworthy, I hope you werent expecting exceptational journalism.

[SectionC3]

42 minutes ago, Mr. WEO said:

Very few jobs  have the majority of full time employees retire as millionaires and still provide them with long term free healthcare/insurance. 

The majority don’t retire as millionaires.  And, the majority don’t retire in a traditional sense.  They just stop playing football and move on to other vocations. 
 

Nobody has a problem asking these guys to take some Toradol on any given Sunday. So nobody should have an issue asking the league and its teams to buck up for medical care.   

42 minutes ago, Mr. WEO said:

Very few jobs  have the majority of full time employees retire as millionaires and still provide them with long term free healthcare/insurance. 

And, define free. In my view, guys like Darryl Talley, for example, earned that health insurance in the field.   The fact that the payments are made after their ability to compete has ended makes no difference to me. 

Edited January 4, 2023 by SectionC3

[Ethan in Cleveland]

3 hours ago, Kmart128 said:

 

Yeah i agree. I think NFL personnel and refs on field were starting standard procedures for injuries. And then i think the teams went to locker room waiting for the NFL league office to get all the information before making a decision.

 

Also think they could have just been trying to make it look like they were gonna play again so fans dont leave and the ambulance has trouble getting to hospital with all the traffic.

Agree. There probably is some standard procedure when a prolonged injury and ambulance is used.  They likely started that process on the field before common sense kicked in that this was beyond even a terrible neck injury that we have seen sadly many too times before.  I'm not going to bash the NFL as this was truly an unprecedented event and they did the best they could.  It will be interesting to see how quickly Goodell and Troy Vincent were made aware of the events and how quickly they intervened.  Maybe that is already known but I haven't seen it. 

[Beck Water]

11 hours ago, redtail hawk said:

I found an article this morning that actually estimated the forces necessary to provoke the arrhythmia (I'm retired now so lots of time and interest, especially in this young man).  They did work on animal models as well.  Other variables included hardness of the object, position of contact (over the left ventricle was worst), age and I forget the other.  But again, 69 is an extremely low number on which to draw conclusions.  One reason I'm skeptical of the diagnosis was that at autopsy, these patients had no or little damage to the heart muscle.  Why would Damar arrest again without another blow to the chest if that were the mechanism?  There are possible explanations but it begs the question.  Finally, it looks like newer studies show closer to a 60% survival but it's not as simple as averaging the various studies.

 

If the blow throws the heart into fibrullation is that due to muscle damage, or does the blow actually damage one of the nodes or bundles?  Because if the node itself is damaged in some way (bruised?) that might explain the repeated cardiac arrest?

 

I agree you don't average studies.  My feeling is a more recent study (assuming both solid work and some procedural or treatment-based explanation of differences), it supercedes the older study.  So if a newer study says hey, portable AEDs are much more common now and that plus bystander CPR make a huge difference to survival, I regard the more recent study as superceding the old.

 

11 hours ago, boyst said:

I wonder if all these cases how many had expert help to the degree he had in just 2 minutes? 

 

As someone said up-thread, outside of a hospital, there is likely no better place to receive care for a true medical emergency than on the field at an NFL game.  And it's possibly better than a hospital, because there's a dedicated team standing by (as opposed to everyone on shift already working like mad) and they have access to something like 90-95% of the initial equipment a trauma center ER would use.

 

10 hours ago, Shake_My_Head said:

Not sure of your point.   My doubt was that there were not NFL-level doctors, trainers and ADE equipment at the games where individuals in that study died.   Prompt CPR was vital to the 10% that did survive, but that figure would probably be higher if those kids had the same resources at hand that Hamlin did.   

 

It's a good question, but you're likely correct IMO.  Also, the older 10% survival abstract says that roughly half the cases occurred at homes, playgrounds, schools etc - outside organized sports.

[EasternOHBillsFan]

10 hours ago, Beck Water said:

I don't put this out here to be a smart ass, but to counter manufactured deadlines of concern like "people SHOULD be concerned if he's still under after over 24 hrs".  We aren't his medical professionals.  We aren't treating him.  Obviously it's optimal if he's conscious and waving as he gets loaded into the ambulance, but he wasn't.  That being the case, his medical team is probably concerned about minimizing brain injury. 

 

It follows that when to be concerned depends on the treatment being administered and the expected course of treatment.

 

I understand that you're not trying to be a smart ass, that's cool. However, the word was concerned.... not ANY speculation as to his condition or what it might be or anything like that based upon ANY sort of medical diagnosis.

 

It has been over 24 hours... so you are not concerned?

[stevestojan]

I am truly impressed with the number of medical professionals, those is the field of science, and other relevant experts we have on this board. Thank you all for your unique perspectives. 
 

(re-read this and it sounded sarcastic. It’s not, I really appreciate the knowledge sharing). 

Edited January 4, 2023 by stevestojan

[Saxum]

3 hours ago, Roy Hobbs said:

Not sure if this is behind a paywall but the BN had this story today. 

 

https://buffalonews.com/news/local/lewiston-natives-heart-stopped-while-playing-college-baseball-hes-making-a-full-recovery/article_f4bd5c12-8baf-11ed-b59c-7fb841b8ca04.html#tracking-source=mp-homepage

 

It is a pay gate not wall meaning there is a way around it but an excellent quote on issue.

 

Quote

Doctors say DiCarlo suffered from an injury called commotio cordis, similar to a hectic disruption of the heart rhythm, throwing the heartbeat off, Dr. Alon Gitig, director of cardiology at Mount Sinai Doctors-Westchester told Parent Heart Watch, which focuses on protecting youth from sudden cardiac arrest. If the heart doesn’t get back into rhythm, it can knock a person unconscious or can be deadly, Gitig said.

 

The injury is very rare, with only 200 documented cases in the U.S. since 1995. When the sudden trauma of getting hit hard in the chest happens at a very specific time in the heartbeat cycle – a 20-millisecond span – this cardiac event can occur.

 

[OrangeBills]

11 hours ago, EasternOHBillsFan said:

 

As soon as Damar's uncle said that they had to administer CPR AGAIN at the hospital, I think that people SHOULD be concerned if he's still under after over 24 hours. This is out of concern for Damar and medical experience probably has nothing so do with it IMHO

 

They just said this was not the case, he was resuscitated just the once on the field, at least that's the latest I've heard

[Joe Ferguson forever]

3 minutes ago, Beck Water said:

 

If the blow throws the heart into fibrullation is that due to muscle damage, or does the blow actually damage one of the nodes or bundles?  Because if the node itself is damaged in some way (bruised?) that might explain the repeated cardiac arrest?

 

I agree you don't average studies.  My feeling is a more recent study (assuming both solid work and some procedural or treatment-based explanation of differences), it supercedes the older study.  So if a newer study says hey, portable AEDs are much more common now and that plus bystander CPR make a huge difference to survival, I regard the more recent study as superceding the old.

 

 

As someone said up-thread, outside of a hospital, there is likely no better place to receive care for a true medical emergency than on the field at an NFL game.  And it's possibly better than a hospital, because there's a dedicated team standing by (as opposed to everyone on shift already working like mad) and they have access to something like 90-95% of the initial equipment a trauma center ER would use.

 

 

It's a good question, but you're likely correct IMO.  Also, the older 10% survival abstract says that roughly half the cases occurred at homes, playgrounds, schools etc - outside organized sports.

from the available studies, it seems there generally is no permanent damage to the myocardium.  The mechanism of inducing the arrhythmia is postulated to be unrelated to cardiac structural changes.  It would not be surprising to see short runs of arrhythmias due to irritability of the conduction system from his overall condition (and perhaps this was misinterpreted by his uncle as cardiac arrest)..  Kidney failure and electrolyte abnormalities are possibilities but there are many more.  Hypoxia involves multiple organ systems.  I think the best we can say is that he remains profoundly ill but hopefully improving.

[H2o]

More good news. 🙏

Quote

Doctors saw promising signs of progress overnight from Damar Hamlin, who remained hospitalized in critical condition as of Wednesday morning, according to a friend and business partner of the Buffalo Bills safety.

 

https://www.espn.com/nfl/story/_/id/35377747/damar-hamlin-showed-signs-overnight-progress-friend-says

[cgang]

8 minutes ago, stevestojan said:

I am truly impressed with the number of medical professionals, those is the field of science, and other relevant experts we have on this board. Thank you all for your unique perspectives. 
 

(re-read this and it sounded sarcastic. It’s not, I really appreciate the knowledge sharing). 

I completely agree.  I’ve learned more about cardiac arrest, emergency response, and other heart ailments and details around treatment protocols (and why) than I ever thought I would.  I really appreciate what folks are bringing to the board.  It helps me make sense of things and reduces my anxiety somewhat as we patiently wait and see how Damar responds.

[Saxum]

1 hour ago, CEN-CAL17 said:

I’m just surprised there has been zero info from the hospital. A statement, breakdown of events…. 
 

Not saying it’s bad, just nothing other than from his personal friends and family.

 

1 hour ago, BillsFanNC said:

 

Unless they get permission from the family I don't think the hospital can release any information other than to confirm that he's there and receiving care.

 

Unless of course it is a reporter releasing information from confidential source who is illegally giving info to reporter which has happened in past.

[Beck Water]

15 minutes ago, Ethan in Cleveland said:

Good post. The hypothermia protocol has changed over the years and there is no standard protocol used.  It sometime depends on how long the cardiac arrest is and what if any activity the patient is showing immediately at ROSC.

 

One of the experts interviewed in the Times article made a point that seems relevant - that the more concerned physicians are about neurological damage, the more aggressive (meaning likely to use/likely to extend duration) they may become with sedation and hypothermia.

 

15 minutes ago, Ethan in Cleveland said:

You are correct a weaning trial would not be tried until the patient is fully rewarmed.  And some centers do a gradual rewarming while others simply remove the cooling device and allow the patient's temperature to rise naturally.  The reality of it is the patients temp is hard to control unless you are using an IV cooling catheter which has mostly fallen out of favor as most institutions are using non-invasive cooling means (ice bags/cooling blankets) as they are cheaper and easier to administer.

 

Hmmm.  Speaking with my engineer hat, the protocols must then vary depending upon the cooling devices available.  Ice bags or cooling gel packs are hard to maintain at intermediate temperatures, but a blanket featuring flexible tubing through which a bath circulates water should be able to be controlled for gradual re-warming.

[Joe Ferguson forever]

3 minutes ago, Beck Water said:

 

One of the experts interviewed in the Times article made a point that seems relevant - that the more concerned physicians are about neurological damage, the more aggressive (meaning likely to use/likely to extend duration) they may become with sedation and hypothermia.

 

 

Hmmm.  Speaking with my engineer hat, the protocols must then vary depending upon the cooling devices available.  Ice bags or cooling gel packs are hard to maintain at intermediate temperatures, but a blanket featuring flexible tubing through which a bath circulates water should be able to be controlled for gradual re-warming.

yes.  It's called a cooling blanket, strangely enough!

[Process]

 

[SydneyBillsFan]

Lots of love for number 3, keep fighting buddy! 

[YoloinOhio]