It was a cold, drizzly March morning this year when Ed Sproull's heart stopped beating.
At 58, he had arrived at work feeling fit and healthy. As he stepped into the elevator at De Lage Landen Financial Services in Wayne, Pennsylvania, he had no reason to suspect he would end up in a limbo between life and death.
He collapsed without a sound. He didn't grab his chest, he didn't indicate any pain or discomfort, he just closed his eyes and slumped down, coffee in hand. Unbeknownst to the colleague with him in the elevator, Sproull's heart had entered a state of electric anarchy, no longer pumping out blood.
Responding to the 911 call from De Lage Landen, EMS Captain Chris Griesser of Berwyn Fire Company arrived less than 15 minutes later. He had to cut through a crowd to get to Sproull.
We shocked him with the AED and we think we have a pulse, one woman kneeling next to the body told Griesser. Sproull's shirt had been ripped open, and electrodes from a so-called automated external defibrillator (AED) were glued to his chest.
Within a few minutes of the cardiac arrest, a company employee trained in cardiopulmonary resuscitation (CPR) had jolted Sproull's heart back to its normal rhythm.
Still, it was far from clear that Sproull would survive. He was in a deep coma and barely breathing. If he made it to the hospital alive, chances were his brain would be so profoundly damaged that he would never be able to live a normal life again.
In fact, the vast majority of the 300,000 Americans who suffer cardiac arrest every year die. Despite massive investments in research and technology, fewer than eight in 100 leave the hospital alive, a rate that has remained stagnant for almost 30 years.
Even if the heart is restarted, only a minority make it. And of those who do, many end up in nursing homes with crippling brain injury.
Doctors say those statistics could change, however, if more people had access to a procedure called therapeutic hypothermia -- cooling the body.
As medical procedures go, it's among the simplest: Chill the patient about six degrees Fahrenheit -- using cold intravenous saline, cooling blankets or ice packs -- and wait 24 hours; then re-warm the patient slowly and cross your fingers.
It's also the only treatment proven to protect the brain after cardiac arrest. In 2009, an analysis of earlier studies showed it increased the chances that people like Sproull would survive with intact brain function by more than half.
Since 2005, it's been a staple part of resuscitation guidelines, inspiring a newfound can-do attitude in a growing number of emergency physicians across the country.
We are pushing into the gray zone and grabbing people back, said Dr. Benjamin Abella, a doctor at the Center for Resuscitation Science at the University of Pennsylvania in Philadelphia.
Yet many hospitals have been slow to pick up the procedure. Those that use it often do so inconsistently, incompletely or with big delays, experts say. What's more, most emergency medical services still rush cardiac arrest patients off to the nearest hospital, making it a high-stakes geographical gamble whether or not that person gets cooled.
There are probably thousands of people in this country who end up having severe brain damage because they don't have access to this treatment, Abella said. It's not subtle.
THE BRAIN ON FIRE
When a cardiac arrest stops the circulation, the first organ to crave oxygen is the brain. But the real trouble doesn't begin until the heart is shocked back to life and starts flooding the brain with fresh oxygen.
In a chemical wildfire of sorts, the cells crank up their activity so much it becomes toxic. Waves of electricity crisscross through the tissue, inflammation revs up, and untold numbers of brain cells switch on genetic suicide programs.
The one thing that has a beneficial effect on every single one of these processes is cooling the tissue, said Dr. Stephan A. Mayer, an expert in cooling and a neurologist at Columbia University in New York.
Imagine a massive chemical burn injury. Cooling the tissue, hypothermia, is like throwing cold water on the whole response.
So when Sproull was wheeled into the emergency room at Paoli Hospital, a dozen minutes from De Lage Landen, cardiologist Dr. Todd Rudo went to work quickly. He wrapped Sproull in ice bags and later blankets with cold fluid circulating through them.
As is commonly done, he also gave him sedatives and muscle relaxants to make sure he wouldn't shiver and reheat.
Meanwhile, Sproull's wife of 23 years, Debbie, was stuck in slow-moving traffic. A veteran nurse practitioner, she had been at work at Bellevue Hospital in New York when she received the bad news. She scrambled to her car, clutching a printout with directions to Paoli.
I was three hours away, in the middle of a nor'easter, trying to drive there, she said. Basically everybody was involved but me.
Knowing nothing of Paoli Hospital, she decided to have Ed transferred to the nationally renowned resuscitation center at the University of Pennsylvania.