Back from the dead, after hibernation saved his life.
One minute, George Frongillo was watching Helen Mirren in “Eye in the Sky” on his Mashpee sun porch and the next, he was dead.
The fact that a year later, he could describe the experience is due to the quick action of his wife, Mashpee first-responders and Cape Cod Hospital cardiac and critical care experts – and a machine that cooled his comatose body to 90 degrees Fahrenheit, in effect putting him into hibernation. He doesn’t like to refer to himself as a miracle man but his story seems, well, miraculous.
“Yeah, Helen Mirren. I love Helen Mirren,” he said recently as he and his wife, Kathy, remembered that day in September 2016. George, 68, actually remembers only the moments before he collapsed. Kathy has to tell the rest of the story.
He became agitated as they were watching the movie. Kathy was already on alert. Although he appears vital, George’s heart had lost 40 percent of its function during a heart attack 15 year earlier and he was scheduled a few days later for a pacemaker and defibrillator implant.
“Do you want me to call the doctor?” Kathy asked as he stood up and turned off the TV. “No, I’m fine,” he said.
And then he crumpled to the floor.
Kathy was already dialing 911. The dispatcher told her to put him on his side – “recovery position” – but when he wasn’t breathing, she was told to start CPR. As she started, police and EMTs came through the door.
And, just as they did, George’s heart stopped.
“I felt him leave me,” Kathy said.
EMTs rushed him to the ambulance where, after several minutes – seven to 10 without a heartbeat, Kathy estimates – they got a pulse and took George to Cape Cod Hospital.
He was back from the dead. But his body’s battle wasn’t over.
Emergency rooms doctors told Kathy that it didn’t look good. Cardiac arrest is triggered by an electrical malfunction in the heart that causes an irregular heartbeat (arrhythmia). When its pumping action is disrupted, the heart cannot pump blood to the brain, lungs and other organs. George’s heart was back in rhythm but they were now worried about his brain, specifically the neurological damage from the lack of oxygen during those critical minutes when his heart wasn’t pumping.
But there might be a way to help George, doctors said: They would cool his body to 90 degrees Fahrenheit for 24 hours or so using a cold saline solution and gel pads; then slowly bring it back up to a normal body temperature. A machine called an Arctic Sun would recirculate cold liquid through the pads and monitor his body temperature. Then, they would use the pads to slowly warm his body back up to a normal body temperature.
The cold would give his body time to heal, they said.
George would remain sedated, both for comfort and to prevent his body from shivering and attempting to warm up. The goal would be to protect cognitive function as much as possible – exactly how much, they couldn’t be sure, but there had been promising results with other patients.
Solving a Cardiac Mystery
When the brain is without oxygen, it releases potentially fatal toxins that can shut the body down, said Paul Evans, M.D., a cardiovascular and critical care specialist with Cape Cod Healthcare, who worked on the case.
“Some of the original thought about this came from victims who fell through the ice in cold climates,” Dr. Evans said. “I’m from Minnesota …. You’d typically see on the news somebody who fell through the ice and was trapped for 60 to 90 minutes. Why is it that these people who were essentially dead for 90 minutes would recover, when heart-attack patients who were dead for five or six minutes, didn’t?”
Doctors aren’t entirely sure why therapeutic hypothermia, or “targeted temperature management,” which includes rewarming the patient, works, Dr. Evans said. Cooling the body prevents it from absorbing the toxins but studies have not yet proved if it’s being cold that prevents the process or it’s not allowing the body to mount a temperature.
“We know from other areas, like traumatic brain injury, that people die when they get a fever,” he said.
The idea of inducing hypothermia as a medical treatment goes all the way back to Hippocrates, according to the Archives of Medical Science. The first studies on using it in cardiac arrest patients were in the 1950s. In May 2017, the American Academy of Neurology issued guidelines based on 50 years of research, saying there was “strong evidence,” that cooling the body to 89.6 to 93.2 degrees Fahrenheit for 24 hours improved the chance of recovering brain function, and that “moderate evidence” supported rewarming.
“While there has been some debate about which cooling protocol is best, our guideline found that both therapies have shown the same result,” the academy said.
The technique is important because there were more than 350,000 out-of-hospital cardiac arrests in the United States in 2016, according to the American Heart Association, with an average survival rate of 12 percent.
Clinicians have traditionally cooled a patient using saline solution and ice packs. The Arctic Sun manufacturer says its machine does the job more quickly and with more precise temperature control and monitoring.
Dr. Evans helped bring the machines to Cape Cod Healthcare by appealing to local Rotary Clubs and other donors to help buy machines. (“It’s very cool,” he said, laughing at his own inability not to make a pun with the vernacular.) CCH now has three, two at Cape Cod Hospital and one at Falmouth Hospital.
Doctors may start cooling a patient with saline even before heading to the heart catheter lab to implant a stent or other life-saving device. The gel pads are then applied once the patient is in the cardiac intensive care unit.
“The number I tell people is that the application of this doubles the chance that you’ll get back the level of cognitive ability that you could go back to work,” Dr. Evans said.
“It’s not over yet”
Standing in the emergency room, Kathy knew little of the details about the hypothermia technique. But she knew George. And she told the medical staff that despite his poor cardiac history, George had the energy and will to fight back.
“I defy you to keep up with him,” she told the doctor. “He’s like the Energizer Bunny.”
It wasn’t all smooth sailing. Clinicians started lowering George’s temperature on Monday night and warming it back up 24 hours later. But George didn’t come out of the coma. Kathy held on to her hope and faith.
“You don’t know him,” I said. “It’s not over yet.”
Finally, on Saturday, George woke up. The neurologist, Kathy said, walked into the family waiting room and said, “Well, George just proved me wrong. He has just aced every test I gave him.”
The road back was not a fast track. It took another week for George to be rid of the breathing tube. There was an infection to deal with and fatigue. There was rehab, which included brain games on his computer and emotional counseling to deal with questions such as, what if Kathy hadn’t been in the room?
These days, George is retired from his job at Staples in Framingham, living in Mashpee full-time, fishing and fixing things around the house, hanging out with Kathy and their four children, walking his two dogs. He feels amazingly good. And grateful. He’s been back to see his caregivers at Cape Cod Hospital.
After Tendoh F. Timoh, MD, FACC, his inpatient cardiologist, called him the luckiest man alive, he bought the doctor a lottery ticket. He’s written notes to his nurses, thanking them for his care.
“Not only were they spectacular people, but it was a spectacularly successful event,” George said. “If they hadn’t given their all, if they hadn’t pushed for things then, this wouldn’t be the case. I wouldn’t be here talking about this right now.”