Vancouver, BC – Ryan Jones' life changed forever on a road in Fort St. John two years ago. His car skidded in the snow; his chest hit the steering wheel, and he went into cardiac arrest. Ryan was flown by air ambulance to Vancouver General Hospital (VGH). He became the first cardiac-arrest patient in Canada to receive a relatively new treatment that saved his brain, his heart, and ultimately his life. "I don't remember much about that day because I was in a coma for weeks after, but I am 100 per cent sure the treatment saved my life," says Ryan.
An MRI confirmed Ryan suffered a hypoxic ischemic brain injury (HIBI), the ensuing brain injury that occurs after cardiac arrest and is the primary reason for death or poor outcomes. The specialized neurocritical care team at VGH, composed of intensive care physicians and neurosurgeons, determined that Ryan was a good candidate for autoregulation monitoring; a procedure where catheters are inserted into the brain to provide crucial clinical information so a patient's care can be customized.
"The catheters revealed extensive damage to Ryan's brain and given that information, we were able optimize his care to prevent further damage and allow his brain to heal." says Dr. Mypinder Sekhon, critical care medicine, Vancouver Coastal Health (VCH). "By ensuring Ryan got the right amount of oxygen to his brain, we were able to limit the secondary neurological damage that we often see in cardiac arrest patients."
Ryan's case became the impetus for a first-in-human study published in the March 19, 2019 edition of Critical Care Medicine. Ten cardiac arrest patients between the ages of 20 and 71 underwent autoregulation monitoring to determine the optimal blood pressure after cardiac arrest to ensure adequate oxygen delivery to the injured brain. The study found the optimal blood pressure in the study group (88.7mmHg) was significantly higher than what international guidelines recommend (> 65mmHg). The optimal pressure varied widely between patients.
"The study is a real eye opener, and highlights the need to treat patients as individuals, rather than taking a one-size fits all approach," says Dr. Sekhon. "Considering up to 45-thousand people in Canada die of cardiac arrest each year, we're hopeful this study will set the foundation for future clinical trials."
VGH is an international leader in the use of autoregulation monitoring. It was first introduced at VGH in 2015 and has helped save the lives of 102 accident victims, skiers, cyclists, and a teenage girl from the Okanagan whose brain was swollen from meningitis.
"At VGH we take care of some of the most critically ill and severely injured patients from across BC and beyond, and provide them with the best treatment from our specialized teams collaborating to improve the health outcomes of our patients," says Dr. Marcel Dvorak, associate senior medical director, VCH.
Two years after his near-fatal accident, Ryan Jones is still recovering and healing.
"Nothing is automatic, so I live one day at a time," says Ryan. His mother, Donna Jones, has a new appreciation for BC's healthcare system. "The doctors in Fort St. John didn't think Ryan would survive the air ambulance trip to Vancouver but they kept him alive…and he made it. When the VGH staff told us about the brain treatment, we knew it might be too late for Ryan, but perhaps could help someone else. We are so grateful to VGH for giving our son a second chance at life."
The specialized equipment required for procedures like Ryan's is funded in part, by VGH & UBC Hospital Foundation. "This new use of autoregulation monitoring is one example of the impact of philanthropy," says Barbara Grantham, CEO, VGH & UBC Hospital Foundation. "By bringing world-class physicians and researchers here, BC residents like Ryan can be the first to benefit from important advancements in health care."