My experience of perioperative cardiac arrest

My cardiac arrest happened at 4.56pm on Friday 1 September 2017, during an operation to remove an abscess in my left breast/chest. I had been terribly ill for three months due to the initial unknown cause, but otherwise I was a healthy thirty-something, and the proud mother of a new baby.

It had been a really difficult time, involving multiple rushes to A&E (several hospitals) and admissions, with extensive tests investigating everything from suspected blood clots on my lungs to abscesses on my spine, with visits from every department they could throw at me.

Infection riddled my body, all through my lymph glands, my muscles and my nerves. I was described as septic and septicaemic and, on my third admission to hospital, I was assigned to the breast surgical team, who realised that if they didn’t operate, I probably wouldn’t last too much longer. Attempts to aspirate the abscess were unsuccessful and antibiotics were not penetrating the abscess, so surgery was the only option.

I was in hospital for a week before the operation (having been admitted over a bank holiday) and was scheduled to be the last operation on the Friday, due to my surgery being ‘dirty’, but I was finally hopeful that my sickness and illness would at last be gone, and I could get back home to my new baby. The nurses helped me wash my hair, to make me feel fresh (as I still couldn’t move properly), and I actually walked the few steps to the operating area (which felt most strange).

The consultant anaesthetist informed me how they would put me to sleep and then left me with the registrar. My sister-in-law is a consultant anaesthetist, so we were joking that we should video call her to check he was doing it correctly. As with any operation, I told them how they’d probably have to wake me up to put me to sleep – I get very relaxed when lying down and doze off of my own accord!

"I immediately sensed something wasn't right"

And, for me, that was as much as I knew until I started to come round in recovery – which is when I immediately sensed something wasn’t right. I couldn’t open my eyes yet but could hear a person sat next to me constantly, and another stood close by. I knew they must be nurses and could hear they were Filipino (I lived there and my husband is Pinoy). So, in my incredibly hazy state, I tried to talk to them in Tagalog. They must’ve thought I was some crazy person mumbling, as they couldn’t understand me.

As a little more time passed, I woke more and tried again, asking why my chest and arm hurt so much. They were so amazed they started chatting back to me, as though we weren’t in a hospital at all. It was then that the surgeon came, stood at the bottom of the bed and told me I’d gone into cardiac arrest during the procedure. Although in my head I knew exactly what that meant, all I could say was ‘Oh, OK’. The poor man was white as a ghost (he’s only in his 40s) and said he’d come back a little later. By that time my husband had arrived. I thought it was weird they’d let him into recovery.

"When I arrested I was in full ventricular fibrillation"

The consultant anaesthetist then arrived to explain what had happened, and that they were taking me up to intensive care. Although the surgeon knew the approximate size of the abscess, when he opened me up he discovered it was all the way up to my chest wall. When I arrested I was in full ventricular fibrillation, and then my ECG showed a long QT (an electrical condition of the heart that increases the risk of dangerous abnormal heart rhythms).

They weren’t sure if the abscess had damaged my chest wall or whether the infection had got through the chest wall, but they think the reason I arrested was due to a complication of the antibiotic I’d been put on mixed with the anaesthetic. I’d incorrectly been marked as allergic for penicillin during earlier admissions at a previous hospital. Although I explained I never have been and since confirmed this, this hospital didn’t undertake any fresh checks, and therefore stuck to their own protocol and treated me as penicillin allergic.

I spent two days in intensive care before being transferred to another hospital with a coronary care unit for a further three weeks undergoing every possible test to understand why I’d arrested. Luckily, I had no damage to my heart, brain or organs, but electrophysiology studies showed a diagnosis of probable CPVT (catecholaminergic polymorphic ventricular tachycardia). Six weeks after the original operation, the same surgeon took me back into surgery to close the hole in my chest – this time I was kept awake as the surgeon was scared about operating on me under general anaesthetic again.

Six weeks after my discharge from the coronary unit, the heart team took me into surgery to insert a subcutaneous implantable cardiac defibrillator (SICD). This was done with a general anaesthetic.

"I know doctors are trained to deal with this, but they’re still human"

As part of my cardiac rehab I had physical classes but also sessions with a psychotherapist, which I really needed to help deal with such a trauma. I asked if it would be possible to meet with the anaesthetists who had cared for me during my operation, as for me this was a really important thing – not only to gain the knowledge of what happened, how it happened, what they did etc. but also to ask them how they were, and how the situation had made them feel. I know doctors are trained to deal with this, but they’re still human, and losing or nearly losing patients must take its toll.

Even now I can remember the face of the surgeon and the consultant anaesthetist when they came to me in the recovery area to explain what had happened. Both were visibly shaken. And to see the registrar anaesthetist again, with whom I’d joked before going to sleep, to then know he was the one doing the chest compressions while the team worked around him, was very emotional. But I’m so glad I did it, and I think it was nice for them too, as they said they never get to see patients after the event or know what’s happened to them.

PTSD "hit me like a wave"

Life post-cardiac arrest is certainly very different. Although I’ve tried to get back into my ‘normal’ life, there is a constant ‘what if?’ in my thoughts. My body has never really recovered, and with the beta blocker medication I’m now on I find it hard to get back to a fitness level that I was before. The SICD is painful, as the nerves and muscle around it are damaged, and I often knock it.

Thoughts of death, and fear of dying are always in the back of mind, and I am often scared to fall asleep in case I don’t wake up again. When PTSD struck 18 months after the events, it hit me like a wave, though subsequent waves have been less severe, and I recognise the symptoms. I stress about needing to go to the doctor for anything, as now I have such a complicated history it makes them worry before they even look at me. Any procedures would require a lengthy protocol. But my biggest worry in life is whether I would or should have a second child, and whether I could cope physically or mentally, if anything went wrong.

Emma's account was originally published in our NAP7 report, 'At the Heart of the Matter: Report and findings of the 7th National Audit Project of the Royal College of Anaesthetists examining Perioperative Cardiac Arrest'. We are very grateful to Emma for sharing her experience with us.