By VIPAN NIKORE, MD

I’ve played over a thousand ice hockey games in my life, but I had no idea that last month’s adult men’s league game in Cleveland would be the most memorable. I grew up in Canada, three blocks from Wayne Gretzky, the greatest hockey player ever, but I wouldn’t be surprised if my recent game was more important than any game that my former neighbor played. This game was literally a matter of life or death.

I almost didn’t show up to the game. I had just landed in Cleveland from New York City after attending a close friend’s wedding. I’d landed at 8:15pm, jumped in my car and dialed into a conference call for my organization uFLOW, arriving and finishing my call barely in time for the 9:30pm puck drop. I didn’t plan my schedule around the game; the timing just happened to work out.

It was close to the end of the 2nd period when I heard our captain, Brandon Dynes, yell something and race off the ice. I soon realized he skated off to call 911. I looked down at the end of the bench and saw that our teammate Harley was unresponsive. Harley is 69 years old (though could pass for 50) and as the eldest player in our men’s league has been an inspiration to many of us. I quickly went over to assess him and found he had no pulse, was not breathing, and not responding to verbal or physical stimuli. I was fortunate that the opposing team had a physician playing as well, Dr. John Wood, an orthopedic surgeon. John quickly came over and could not find a pulse either. Knowing end organ damage such a anoxic brain injury can occur quickly, I grabbed Harley and layed him on the bench and started compressions, pressing his chest extra hard knowing I was going through a layer of hockey pads. I later quickly ripped off his pads off to assure better compressions.

We were lucky to have many people providing great help: calling 911, getting the automatic external defibrillator (AED), and providing history; others with health and life support experience contributed critical medical and resuscitation observations. With obviously no way to administer oxygen, we began mouth-to-mouth while continuing CPR. Harley continued to have no pulse for over five minutes. Finally, another player skated the AED across the ice to us, and John placed the pads on his chest. Rhythm was analyzed and electrical shock was advised. John then made sure everyone was clear and pressed the shock button. Still no pulse. I could feel my teammate’s hands getting colder as blood flow was being compromised. I began to worry as knew that most studies show that witnessed arrests have a survival percentage in the single digits.

I couldn’t believe what was happening. I was playing hockey one moment, frustrated that their goalie was saving absolutely everything I shot at him, and the next moment I was doing CPR, mouth-to-mouth, and defibrillating my teammate, all in my full hockey gear. I’ve lost count of how many code blues (cardiac arrests) I’ve been involved in, but this was my first with hockey skates on and without a massive medical team, advanced equipment, and powerful IV medications. The plea “Don’t die on us” always fills my head in these situations, but knowing this was a friend and teammate, it felt even more personal.

We continued CPR and soon checked his heart rhythm again with the AED, but this time it advised against a shock. He likely was previously in ventricular fibrillation and then converted into asystole or PEA arrest after the shock, as he still had no pulse. The ambulance arrived, and I gave Emergency Medical Services the story.  They lifted him on the board in preparation to transport him to the closest emergency department. Around that time I heard a member of EMS say, “He’s got a pulse.” Thank God. What a relief. Harley was lifted into the ambulance, and we waited anxiously before two EMTs came out and thanked us. His pulse and vital signs had stabilized. I quickly changed out of my sweaty hockey gear and drove to the hospital to check on him.

It was truly a team effort, and I wish everyone involved last night could have been there to hear the emergency department doctor tell me, “You guys saved his life.” By then Harley was alert and talking, and his first words to me were “Did we win?” He looked well but had EKG changes and was soon transferred to the Cleveland Clinic Cardiac Intensive Care Unit. He had a 99% occlusion of his left anterior descending (LAD) coronary artery (one of the heart’s primary heart vessels) and our interventional cardiologists at the Cleveland Clinic proceeded to place a cardiac stent. I stopped by while at work everyday to see him and watched him improve. He was soon discharged and is currently recovering well.

What happened during my game was similar to what happened to Jiri Fischer of the Detroit Red Wings in 2005.  You can see it here (though note it was not a seizure as the coach says):

The reasons for the heart malfunctioning in these cases were different, and of course there were 15,000 fans and a medical team at the Detroit game, compared to a whopping five fans and no medical team at my game. However, the sequence was similar: Player retreats to the bench after exerting himself on a shift and soon becomes unresponsive. CPR is performed and an AED is applied, showing that the heart is in ventricular fibrillation. The patient is shocked. Heart rhythm is restored and vitals stabilized.

AED’s should be available where people exert themselves, where there is a high volume of people, or where people at risk for a heart attack live. They should be placed in easily accessible locations to assure quick retrieval. When a patient’s heart stops pumping properly and blood no longer is circulating, an abnormal quivering rhythm called ventricular fibrillation (VFib) sometimes is the cause. VFib is generally a by product of another underlying heart abnormality, a blocked heart vessel in my teammates case. A patient in VFib needs to quickly have normal heart rhythm restored by a defibrillator, otherwise he or she will likely die. Defibrillation needs to happen fast. Of course not all cardiac arrests are VFib, and the patient’s heart must be in the abnormal rhythms of VFib or ventricular tachycardia to be shocked.

CPR is of course critical to temporarily allow blood to continue to be pumped to the body’s vital organs. CPR needs to happen immediately once it is recognized there is no pulse. It is important for everyone in the public to know how to do CPR. While I’ve spent years working and studying to become a physician, the skills used last month were just basic life support skills that anyone can learn. The American Heart Association and Heart and Stroke Foundation of Canada are good sites where basic CPR as well as advanced classes are listed: http://www.americanheart.org and http://www.heartandstroke.com. The sites also have other great tools for the public, such as sections on heart attack and stroke warning signs.

I’ve been a part of some fantastic feel-good stories in my young career, but on the job there is so much happening that often you don’t reflect on a big winning moment.  You’ll walk in a room with your medical team, save a life, and then just carry on as if nothing happened. Such events in the hospital are routine. That evening when I “dropped the gloves,” which in hockey parlance implies getting into a fight (I clearly “dropped” them for another reason here), it felt different. That evening, we applied the fundamentals of medicine in its raw form. All the studying and work over the years was worth it for that moment.

Vipan Nikore, MD, MBA, is an Internal Medicine Resident Physician at the Cleveland Clinic. He received an MBA from the Yale School of Management, an MD degree from the University of Illinois-Chicago, and a BS in computer science and software engineering from the University of Western Ontario. He has led projects at UNICEF in India, the WHO in Geneva, IBM, Sun Microsystems, Citibank, UCLA, and the Ontario Ministry of Health. He is the President and Founder of the youth leadership non-profit Urban Future Leaders of the World (uFLOW). His posts are personal views and do not necessarily reflect the opinions or positions of the Cleveland Clinic.