Sun, Oct 07, 2007 - Page 17 News List

Heart, interrupted

An ill-timed kick from a horse sends an 11-year-old girl into a rare form of cardiac arrest that only occurs if the heart is jolted in the 15-millisecond pause between heartbeats and almost always results in death

By STEPHANIE EARLS  /  NY TIMES NEWS SERVICE, ALBANY, NEW YORK

He'd only planned to be here for a few hours. He had to be back at work, for a 5pm shift. Allison was scheduled to ride early that morning, around 10am, but her time got bumped back to after lunch.

The skies were bruised, threatening rain. He stood by a paddock with his wife, older daughter Caroline and Allison.

His eyes finally landed on the paramedics, tending to a girl in the far paddock. She was on the ground. It looked like she'd been thrown from her horse. Burton considered going over, offering to help, but then the girl stood up.

Guess they don't need me, Burton thought.

But then the murmuring began. First, just buzz: Someone was hurt. The murmurs got louder: someone was really hurt. Without a word to his family, he turned and began to chase the murmurs to their source.

Delana's heart had stopped for nearly two minutes.

Two minutes and 10 seconds, 15 seconds, 30. Three minutes.

As he walked, Burton considered what he might find. Probably an adult, someone's mom or dad who'd passed out from the heat and the crowd. But then he saw the body:

Small legs, small arms, prim riding outfit. A child. Nearby, a tall woman with long blond hair sobbed. Had to be the mother.

The doctor dropped to one knee by Delana's body. "What happened?"

One of the two women by Delana's side told him. The girl got kicked by a horse, then she seized.

"Does she have a pulse?"

No.

One diagnosis, an awful diagnosis, leapt to mind.

It's commotio cordis. My God, it's commotio cordis.

Burton had always been drawn to cardiac medicine, so he knew about commotio cordis. Still, he'd never seen it. Commotio cordis victims didn't make it as far as the hospital.

"I'm an ER doctor. Who are you?"

One was a trauma nurse, the other a cardiology nurse practitioner.

"What were the odds?" thought Burton. Two nurses and a doctor, right here, right now? Still, he doubted there was anything even they could do. If it was commotio cordis, this little girl was beyond help. She was what ER people refer to as DRT.

Dead Right There.

Another five, six seconds.

Delana's skin was ashen. Burton quickly checked her - her airway, her pulse. The little girl's lips were blue. Burton gave her four quick breaths of mouth-to-mouth. Nothing. She was in full cardiac arrest.

One second more, then two, three.

Delana's lungs had shut down.

Four seconds.

Burton knew what he had to do. Chest compressions. It was the only thing left, but it's not something a doctor begins lightly, especially on a child. Odds are you'll crack a rib. Odds are it won't work, especially if this was commotio cordis. Still, once you start compressions, you don't stop until the patient wakes up, or is pronounced dead.

He placed his palms on Delana's sternum, raised himself up on his knees so he was positioned right above her body. He straightened his arms, locked his elbows, and then looked down at her face one last time. She was dead. And she needed him, right now.

Burton pressed using his entire body weight, pushing furiously, not thinking about damages or cracked ribs or Allison.

One-two-three-four ... five.

Inside Delana's chest, her rib cage, resilient as only a child's is, flexed without cracking. Under the pressure of Burton's compressions, her heart was squeezed between her chest wall and spine. The electrical impulses controlling the lub-dub, the impulses that had been short-circuited and sent into fibrillation by the horse kick, reacted to the thump. They charged, restarting from scratch.

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