Buffalo Safety-Damar Hamlin is awake and **Bills at Bengals** Game has been Canceled (1 Viewer)

[Anarchy99]

Agree the bolded is extremely important, but are we sure Hamlin had return of spontaneous circulation in seconds? I was under the impression he required ~10 minutes of CPR.

I am not a medical expert, but my understanding is that as soon as CPR begins that blood flow (and oxygen) to the brain resumes and that is the biggest factor in outcome. I don't know how many minutes of CPR were performed before the AED was used and brought his heart back to regular rhythm, or if that even matters as long as the CPR is pumping the blood manually, but the reports say his heartbeat had resumed on its own before he left the field.

High quality CPR can briefly keep someone alive, but it’s no substitute for the return of spontaneous circulation. Because CPR is seldom performed flawlessly, prolonged resuscitation times are associated with worse outcomes, principally from anoxic brain injury (brain damage from not enough oxygenated blood circulating).

Immediate CPR and access to an AED are part of the best case scenario, but prolonged resuscitation (more than 3-4 minutes) is prognostically bad for full recovery. While rare exceptions occur, hardly anyone survives when resuscitation extends beyond 10 minutes.

Based on what you've heard so far, are you discouraged regarding Hamlin's long-term prognosis?

Too few details, and it’s too early, but requiring mechanical ventilation post-resuscitation isn’t ideal. Sometimes a shock is all it takes. On the other hand, it’s good news they needed to sedate him while on the vent, as it suggests enough functionality to fight the tube in his airway.

My wife has been a nurse for 25 years including multiple years in Neurology. She mentioned she thought Hamlin suffered a neurological event after he collapsed and fell based on his arm movements (blood clot, stoke, etc.). She believes he suffered a brain related injury before the entire CPR process even got started (in addition to potential limited blood flow to the brain risk from the extended CPR). That's just her opinion from watching the replay . . . curious if you had an opinion on that. She fears he's more at risk from the neurological event more than the cardiac event.

I think this scenario is extremely unlikely I've run between 1500-2000 codes and IMO this was cardiac based on the information publicly available and visually. He is surely at risk for a neurological event from anoxia, but I think it is very unlikely that the inciting event was neurological in origin

I don’t know the medical terms, but she said his arms / hands were inverted or twitching either as he fell or just after he had fallen. She said that was a classic sign of a neurological event.

 

[ghostguy123]

It may be well done past time that we reconsider how this game is played. Player safety is critical and the NFL needs to step up and see what changes are needed.

Ummm, if THAT play can't happen, then football can't happen. That was as routine as it gets

This is pretty much where we are.

In its current state, I am not sure that football can happen.

Lol. Wut?

 

[GroveDiesel]

Agree the bolded is extremely important, but are we sure Hamlin had return of spontaneous circulation in seconds? I was under the impression he required ~10 minutes of CPR.

I am not a medical expert, but my understanding is that as soon as CPR begins that blood flow (and oxygen) to the brain resumes and that is the biggest factor in outcome. I don't know how many minutes of CPR were performed before the AED was used and brought his heart back to regular rhythm, or if that even matters as long as the CPR is pumping the blood manually, but the reports say his heartbeat had resumed on its own before he left the field.

High quality CPR can briefly keep someone alive, but it’s no substitute for the return of spontaneous circulation. Because CPR is seldom performed flawlessly, prolonged resuscitation times are associated with worse outcomes, principally from anoxic brain injury (brain damage from not enough oxygenated blood circulating).

Immediate CPR and access to an AED are part of the best case scenario, but prolonged resuscitation (more than 3-4 minutes) is prognostically bad for full recovery. While rare exceptions occur, hardly anyone survives when resuscitation extends beyond 10 minutes.

Correct me if I am wrong, but has it actually been released that he was in ventricular fibrillation? Probably statistically most likely, but that is one of the assumptions I've been cautioning against.
For all we know, he was in ventricular tachycardia with a low enough blood pressure / faint or no pulse that required CPR to be started. My point is, he may have significant blood flow and oxygen delivery in those 9 minutes. This isn't an asystole case. I've had plenty of cardiac cases in v fib v tach that survived fine with 9 minutes of cpr

I don’t think any of that info has been released. The only new info is from ESPN’s Coley Harvey reporting that Hamlin’s uncle told him that Hamlin has to be revived a 2nd time after he got to the hospital and that there is concern of lung damage. He also said that they had started Hamlin on 100% oxygen when he first got there but is down to 50% oxygen now.

 

[Rubi]

I can't even imagine how the Bills and Bengals teams will be able to prepare for Sunday

Yea that’s an underrated point. They have to go watch film and practice this week? Going to be hard.

The latest I read is that the Bills haven’t even thought about watching film, gameplanning, practicing, etc at this point. I’d say there’s a decent chance they decide to forfeit. Or maybe go play with basically no gameplanning and like it’s a preseason game (the one positive is that it’s a division foe they already know a lot about).

The Bills have plenty of time to prepare for New England logistically. Teams play on Sunday,basically get Monday off and are forced to play on Thursday. The unknown is how prepared they will be mentally. It's tough and awful we have to talk about something like this. I wish The Bills and Bengals the best.

 

[growlers]

Agree the bolded is extremely important, but are we sure Hamlin had return of spontaneous circulation in seconds? I was under the impression he required ~10 minutes of CPR.

I am not a medical expert, but my understanding is that as soon as CPR begins that blood flow (and oxygen) to the brain resumes and that is the biggest factor in outcome. I don't know how many minutes of CPR were performed before the AED was used and brought his heart back to regular rhythm, or if that even matters as long as the CPR is pumping the blood manually, but the reports say his heartbeat had resumed on its own before he left the field.

High quality CPR can briefly keep someone alive, but it’s no substitute for the return of spontaneous circulation. Because CPR is seldom performed flawlessly, prolonged resuscitation times are associated with worse outcomes, principally from anoxic brain injury (brain damage from not enough oxygenated blood circulating).

Immediate CPR and access to an AED are part of the best case scenario, but prolonged resuscitation (more than 3-4 minutes) is prognostically bad for full recovery. While rare exceptions occur, hardly anyone survives when resuscitation extends beyond 10 minutes.

Based on what you've heard so far, are you discouraged regarding Hamlin's long-term prognosis?

Too few details, and it’s too early, but requiring mechanical ventilation post-resuscitation isn’t ideal. Sometimes a shock is all it takes. On the other hand, it’s good news they needed to sedate him while on the vent, as it suggests enough functionality to fight the tube in his airway.

My wife has been a nurse for 25 years including multiple years in Neurology. She mentioned she thought Hamlin suffered a neurological event after he collapsed and fell based on his arm movements (blood clot, stoke, etc.). She believes he suffered a brain related injury before the entire CPR process even got started (in addition to potential limited blood flow to the brain risk from the extended CPR). That's just her opinion from watching the replay . . . curious if you had an opinion on that. She fears he's more at risk from the neurological event more than the cardiac event.

I think this scenario is extremely unlikely I've run between 1500-2000 codes and IMO this was cardiac based on the information publicly available and visually. He is surely at risk for a neurological event from anoxia, but I think it is very unlikely that the inciting event was neurological in origin

I don’t know the medical terms, but she said his arms / hands were inverted or twitching either as he fell or just after he had fallen. She said that was a classic sign of a neurological event.

This is just myoclonus that occurs commonly when blood pressure drops suddenly. See it all the time with vasovagal syncope. No prognostic or diagnostic value

 

[ghostguy123]

I can't even imagine how the Bills and Bengals teams will be able to prepare for Sunday

Yea that’s an underrated point. They have to go watch film and practice this week? Going to be hard.

The sooner they do the better. Moving on is actually a healthy thing to do

 

[Rubi]

It may be well done past time that we reconsider how this game is played. Player safety is critical and the NFL needs to step up and see what changes are needed.

Ummm, if THAT play can't happen, then football can't happen. That was as routine as it gets

This is pretty much where we are.

In its current state, I am not sure that football can happen.

Lol. Wut?

My thought exactly,only I didn't laugh. I crinkled my face

 

[growlers]

Agree the bolded is extremely important, but are we sure Hamlin had return of spontaneous circulation in seconds? I was under the impression he required ~10 minutes of CPR.

I am not a medical expert, but my understanding is that as soon as CPR begins that blood flow (and oxygen) to the brain resumes and that is the biggest factor in outcome. I don't know how many minutes of CPR were performed before the AED was used and brought his heart back to regular rhythm, or if that even matters as long as the CPR is pumping the blood manually, but the reports say his heartbeat had resumed on its own before he left the field.

High quality CPR can briefly keep someone alive, but it’s no substitute for the return of spontaneous circulation. Because CPR is seldom performed flawlessly, prolonged resuscitation times are associated with worse outcomes, principally from anoxic brain injury (brain damage from not enough oxygenated blood circulating).

Immediate CPR and access to an AED are part of the best case scenario, but prolonged resuscitation (more than 3-4 minutes) is prognostically bad for full recovery. While rare exceptions occur, hardly anyone survives when resuscitation extends beyond 10 minutes.

Correct me if I am wrong, but has it actually been released that he was in ventricular fibrillation? Probably statistically most likely, but that is one of the assumptions I've been cautioning against.
For all we know, he was in ventricular tachycardia with a low enough blood pressure / faint or no pulse that required CPR to be started. My point is, he may have significant blood flow and oxygen delivery in those 9 minutes. This isn't an asystole case. I've had plenty of cardiac cases in v fib v tach that survived fine with 9 minutes of cpr

I don’t think any of that info has been released. The only new info is from ESPN’s Coley Harvey reporting that Hamlin’s uncle told him that Hamlin has to be revived a 2nd time after he got to the hospital and that there is concern of lung damage. He also said that they had started Hamlin on 100% oxygen when he first got there but is down to 50% oxygen now.

it is quite common for someone who collapses from a cardiac rhythm issue to have another occurrence. And "lung damage" description may have gone from RN to uncle to EPSN reporter to being reported. Maybe he aspirated a little, maybe he has a pulmonary contusion from the CPR, etc. I wouldn't read anything into any of this stuff at this point, its just noise.

 

[Terminalxylem]

Agree the bolded is extremely important, but are we sure Hamlin had return of spontaneous circulation in seconds? I was under the impression he required ~10 minutes of CPR.

I am not a medical expert, but my understanding is that as soon as CPR begins that blood flow (and oxygen) to the brain resumes and that is the biggest factor in outcome. I don't know how many minutes of CPR were performed before the AED was used and brought his heart back to regular rhythm, or if that even matters as long as the CPR is pumping the blood manually, but the reports say his heartbeat had resumed on its own before he left the field.

High quality CPR can briefly keep someone alive, but it’s no substitute for the return of spontaneous circulation. Because CPR is seldom performed flawlessly, prolonged resuscitation times are associated with worse outcomes, principally from anoxic brain injury (brain damage from not enough oxygenated blood circulating).

Immediate CPR and access to an AED are part of the best case scenario, but prolonged resuscitation (more than 3-4 minutes) is prognostically bad for full recovery. While rare exceptions occur, hardly anyone survives when resuscitation extends beyond 10 minutes.

Based on what you've heard so far, are you discouraged regarding Hamlin's long-term prognosis?

Too few details, and it’s too early, but requiring mechanical ventilation post-resuscitation isn’t ideal. Sometimes a shock is all it takes. On the other hand, it’s good news they needed to sedate him while on the vent, as it suggests enough functionality to fight the tube in his airway.

My wife has been a nurse for 25 years including multiple years in Neurology. She mentioned she thought Hamlin suffered a neurological event after he collapsed and fell based on his arm movements (blood clot, stoke, etc.). She believes he suffered a brain related injury before the entire CPR process even got started (in addition to potential limited blood flow to the brain risk from the extended CPR). That's just her opinion from watching the replay . . . curious if you had an opinion on that. She fears he's more at risk from the neurological event more than the cardiac event.

Yeah, I noticed he flexed his arms after he fell, which may have been something called decorticate posturing. I suppose this may have been the result of the cardiac arrest itself, but generally implies a severe insult to the central nervous system.

But to be clear, I think the primary process is cardiac. As others have stated, commotio cordis seems the most likely diagnosis based on what we know.

 

[ghostguy123]

Guys, tragic stuff happens every day. Hundreds or thousands of times every day. We move on. Humans move on. If we didn't move on from tragic things, what the hell would this country look like right now???
It hurts. It sucks. It sucks not knowing. It will hurt regardless of the outcome cause even with a recovery he never plays again IMO.
Moving on isn't just something I hope they do, it's something they NEED to do, that they SHOULD do. The amount of time that takes is FAR from decided. He might recover and be good tomorrow. He might pass away on Saturday which would obviously make playing not possible for the Bills. Who knows.
All I know is they WILL move on, they HAVE to move on, they SHOULD move on.
Fans can/will/should as well.

 

[growlers]

Agree the bolded is extremely important, but are we sure Hamlin had return of spontaneous circulation in seconds? I was under the impression he required ~10 minutes of CPR.

I am not a medical expert, but my understanding is that as soon as CPR begins that blood flow (and oxygen) to the brain resumes and that is the biggest factor in outcome. I don't know how many minutes of CPR were performed before the AED was used and brought his heart back to regular rhythm, or if that even matters as long as the CPR is pumping the blood manually, but the reports say his heartbeat had resumed on its own before he left the field.

High quality CPR can briefly keep someone alive, but it’s no substitute for the return of spontaneous circulation. Because CPR is seldom performed flawlessly, prolonged resuscitation times are associated with worse outcomes, principally from anoxic brain injury (brain damage from not enough oxygenated blood circulating).

Immediate CPR and access to an AED are part of the best case scenario, but prolonged resuscitation (more than 3-4 minutes) is prognostically bad for full recovery. While rare exceptions occur, hardly anyone survives when resuscitation extends beyond 10 minutes.

Based on what you've heard so far, are you discouraged regarding Hamlin's long-term prognosis?

Too few details, and it’s too early, but requiring mechanical ventilation post-resuscitation isn’t ideal. Sometimes a shock is all it takes. On the other hand, it’s good news they needed to sedate him while on the vent, as it suggests enough functionality to fight the tube in his airway.

My wife has been a nurse for 25 years including multiple years in Neurology. She mentioned she thought Hamlin suffered a neurological event after he collapsed and fell based on his arm movements (blood clot, stoke, etc.). She believes he suffered a brain related injury before the entire CPR process even got started (in addition to potential limited blood flow to the brain risk from the extended CPR). That's just her opinion from watching the replay . . . curious if you had an opinion on that. She fears he's more at risk from the neurological event more than the cardiac event.

Yeah, I noticed he flexed his arms after he fell, which may have been something called decorticate posturing. I suppose this may have been the result of the cardiac arrest itself, but generally implies a severe insult to the central nervous system.

But to be clear, I think the primary process is cardiac. As others have stated, commotio cordis seems the most likely diagnosis based on what we know.

not when it's transient
that was just myoclonus, very common observation in these circumstances
IMO

 

[ChiefD]

I remember when Jovan Belcher killed his girlfriend and then himself on the front steps of the Chiefs practice facility. In front of the head coach and the GM. That was on a Saturday and they played THE NEXT DAY.

Whether that was the right decision or not…who knows….but they came together and won the game.

Whatever the Bills decide to do will be the right decision for them. But there is precedent for teams to come together and play. Someone mentioned above about the Henry death and the game a few days later.

I just hope the Bills players can get the help they need if they need it and proceed when they are ready.

 

[amnesiac]

Agree the bolded is extremely important, but are we sure Hamlin had return of spontaneous circulation in seconds? I was under the impression he required ~10 minutes of CPR.

I am not a medical expert, but my understanding is that as soon as CPR begins that blood flow (and oxygen) to the brain resumes and that is the biggest factor in outcome. I don't know how many minutes of CPR were performed before the AED was used and brought his heart back to regular rhythm, or if that even matters as long as the CPR is pumping the blood manually, but the reports say his heartbeat had resumed on its own before he left the field.

High quality CPR can briefly keep someone alive, but it’s no substitute for the return of spontaneous circulation. Because CPR is seldom performed flawlessly, prolonged resuscitation times are associated with worse outcomes, principally from anoxic brain injury (brain damage from not enough oxygenated blood circulating).

Immediate CPR and access to an AED are part of the best case scenario, but prolonged resuscitation (more than 3-4 minutes) is prognostically bad for full recovery. While rare exceptions occur, hardly anyone survives when resuscitation extends beyond 10 minutes.

Based on what you've heard so far, are you discouraged regarding Hamlin's long-term prognosis?

Too few details, and it’s too early, but requiring mechanical ventilation post-resuscitation isn’t ideal. Sometimes a shock is all it takes. On the other hand, it’s good news they needed to sedate him while on the vent, as it suggests enough functionality to fight the tube in his airway.

My wife has been a nurse for 25 years including multiple years in Neurology. She mentioned she thought Hamlin suffered a neurological event after he collapsed and fell based on his arm movements (blood clot, stoke, etc.). She believes he suffered a brain related injury before the entire CPR process even got started (in addition to potential limited blood flow to the brain risk from the extended CPR). That's just her opinion from watching the replay . . . curious if you had an opinion on that. She fears he's more at risk from the neurological event more than the cardiac event.

I think this scenario is extremely unlikely I've run between 1500-2000 codes and IMO this was cardiac based on the information publicly available and visually. He is surely at risk for a neurological event from anoxia, but I think it is very unlikely that the inciting event was neurological in origin

I don’t know the medical terms, but she said his arms / hands were inverted or twitching either as he fell or just after he had fallen. She said that was a classic sign of a neurological event.

This is just myoclonus that occurs commonly when blood pressure drops suddenly. See it all the time with vasovagal syncope. No prognostic or diagnostic value

I appreciate everyone’s contributions, but you sound like you really know your stuff.

Thank you for chiming in.

 

[Army Eye]

In its current state, I am not sure that football can happen.

If football can't happen because of the possibility of commotio cordis, then, that's only the beginning. Baseball and hockey are out. Maybe some others too

 

[growlers]

Agree the bolded is extremely important, but are we sure Hamlin had return of spontaneous circulation in seconds? I was under the impression he required ~10 minutes of CPR.

I am not a medical expert, but my understanding is that as soon as CPR begins that blood flow (and oxygen) to the brain resumes and that is the biggest factor in outcome. I don't know how many minutes of CPR were performed before the AED was used and brought his heart back to regular rhythm, or if that even matters as long as the CPR is pumping the blood manually, but the reports say his heartbeat had resumed on its own before he left the field.

High quality CPR can briefly keep someone alive, but it’s no substitute for the return of spontaneous circulation. Because CPR is seldom performed flawlessly, prolonged resuscitation times are associated with worse outcomes, principally from anoxic brain injury (brain damage from not enough oxygenated blood circulating).

Immediate CPR and access to an AED are part of the best case scenario, but prolonged resuscitation (more than 3-4 minutes) is prognostically bad for full recovery. While rare exceptions occur, hardly anyone survives when resuscitation extends beyond 10 minutes.

Based on what you've heard so far, are you discouraged regarding Hamlin's long-term prognosis?

Too few details, and it’s too early, but requiring mechanical ventilation post-resuscitation isn’t ideal. Sometimes a shock is all it takes. On the other hand, it’s good news they needed to sedate him while on the vent, as it suggests enough functionality to fight the tube in his airway.

My wife has been a nurse for 25 years including multiple years in Neurology. She mentioned she thought Hamlin suffered a neurological event after he collapsed and fell based on his arm movements (blood clot, stoke, etc.). She believes he suffered a brain related injury before the entire CPR process even got started (in addition to potential limited blood flow to the brain risk from the extended CPR). That's just her opinion from watching the replay . . . curious if you had an opinion on that. She fears he's more at risk from the neurological event more than the cardiac event.

I think this scenario is extremely unlikely I've run between 1500-2000 codes and IMO this was cardiac based on the information publicly available and visually. He is surely at risk for a neurological event from anoxia, but I think it is very unlikely that the inciting event was neurological in origin

I don’t know the medical terms, but she said his arms / hands were inverted or twitching either as he fell or just after he had fallen. She said that was a classic sign of a neurological event.

This is just myoclonus that occurs commonly when blood pressure drops suddenly. See it all the time with vasovagal syncope. No prognostic or diagnostic value

I appreciate everyone’s contributions, but you sound like you really know your stuff.

Thank you for chiming in.

No problem. I was an NFL UNC for 2 years as well as an ER doc for >20. There is a lot of NFL training we do with the entire sideline team for this exact scenario

 

[fred_1_15301]

In its current state, I am not sure that football can happen.

If football can't happen because of the possibility of commotio cordis, then, that's only the beginning. Baseball and hockey are out. Maybe some others too

What do you mean by “football can’t happen?” There is a risk associated with anything. This is obviously an incredibly rare event. Certainly not enough to cancel an entire sport.

 

[SoBeDad]

When Hamlin initially got up, he didn't struggle to get up or stagger, like a boxer might. And then he went limp, like someone fainting in response to a sudden drop in blood pressure. I'm no doctor, but the signs point to a purely cardiac event.

 

[dickey moe]

... if THAT play can't happen, then football can't happen. That was as routine as it gets

That's what got to me watching it well after the fact. It was a normal-looking tackle -- not a spear, or a defenseless player, or a late hit, or a Vontaze Burfict blow-up job. Totally normal, 20-times-a-game tackle.

And then Hamlin even pops up afterwards. For maybe a three-count ... no apparent daze, no wobbly steps, nothing like that. Just pops up from the tackle ... a few seconds ... and then the unthinkable.

If it was actually commotio cordis, considering the number of high impact contact events throughout the the history of the NFL, I think it shows just how rare an event it is.

 

[ignatiusjreilly]

Agree the bolded is extremely important, but are we sure Hamlin had return of spontaneous circulation in seconds? I was under the impression he required ~10 minutes of CPR.

I am not a medical expert, but my understanding is that as soon as CPR begins that blood flow (and oxygen) to the brain resumes and that is the biggest factor in outcome. I don't know how many minutes of CPR were performed before the AED was used and brought his heart back to regular rhythm, or if that even matters as long as the CPR is pumping the blood manually, but the reports say his heartbeat had resumed on its own before he left the field.

High quality CPR can briefly keep someone alive, but it’s no substitute for the return of spontaneous circulation. Because CPR is seldom performed flawlessly, prolonged resuscitation times are associated with worse outcomes, principally from anoxic brain injury (brain damage from not enough oxygenated blood circulating).

Immediate CPR and access to an AED are part of the best case scenario, but prolonged resuscitation (more than 3-4 minutes) is prognostically bad for full recovery. While rare exceptions occur, hardly anyone survives when resuscitation extends beyond 10 minutes.

Based on what you've heard so far, are you discouraged regarding Hamlin's long-term prognosis?

Too few details, and it’s too early, but requiring mechanical ventilation post-resuscitation isn’t ideal. Sometimes a shock is all it takes. On the other hand, it’s good news they needed to sedate him while on the vent, as it suggests enough functionality to fight the tube in his airway.

My wife has been a nurse for 25 years including multiple years in Neurology. She mentioned she thought Hamlin suffered a neurological event after he collapsed and fell based on his arm movements (blood clot, stoke, etc.). She believes he suffered a brain related injury before the entire CPR process even got started (in addition to potential limited blood flow to the brain risk from the extended CPR). That's just her opinion from watching the replay . . . curious if you had an opinion on that. She fears he's more at risk from the neurological event more than the cardiac event.

I think this scenario is extremely unlikely I've run between 1500-2000 codes and IMO this was cardiac based on the information publicly available and visually. He is surely at risk for a neurological event from anoxia, but I think it is very unlikely that the inciting event was neurological in origin

I don’t know the medical terms, but she said his arms / hands were inverted or twitching either as he fell or just after he had fallen. She said that was a classic sign of a neurological event.

This is just myoclonus that occurs commonly when blood pressure drops suddenly. See it all the time with vasovagal syncope. No prognostic or diagnostic value

I appreciate everyone’s contributions, but you sound like you really know your stuff.

Thank you for chiming in.

No problem. I was an NFL UNC for 2 years as well as an ER doc for >20. There is a lot of NFL training we do with the entire sideline team for this exact scenario

Truly appreciate you sharing your perspective (same goes for @Terminalxylem ).

What is the range of outcomes for an event like this? Will there be a point in the next few days/weeks where we can safely say he's out of the woods? Is it possible he has lifelong complications? I believe others have mentioned that Chris Pronger made a full recovery and resumed his career

 

[dickey moe]

Dr. David Chao is on the Jim Rome show right now and he said he's cautiously optimistic about Hamlin's recovery. He said it was crucial that the medical staff were able to restore Hamlin's heartbeat and breathing right there on the field (i.e., within seconds).

Agree the bolded is extremely important, but are we sure Hamlin had return of spontaneous circulation in seconds? I was under the impression he required ~10 minutes of CPR.

Maybe "restore" wasn't the best term to use - perhaps "facilitate/maintain through the use of CPR and AED" is better? I'm not a medical professional. I was just trying to convey that a respected guy in sports medicine seems to be optimistic about Hamlin's prognosis.

 

[Ministry of Pain]

I can't even imagine how the Bills and Bengals teams will be able to prepare for Sunday

The Bengals lost Chris Henry and played 3 days later. It sucks but things happen. Not trying to sound like "get over it", if anyone is too affected to play even by Sunday then that is okay for them to not play, but life just goes on for most people.

ETA: And life just goes on does not mean forget about it, it just means that life goes on.

Wow, Chris Henry
Think he fell off the back of a truck or something
Was nothing on a football field but your point is well taken and I applaud you for remembering him

 

[Ministry of Pain]

Honestly, from a mental health perspective, the league should do everything is reasonably can to keep the Bills players out of the Cinci stadium for the remainder of this year.

Agreed

Although I would say the players traumatized by [last] night is not limited to the 96 players who dressed last night

This ****ed with everybody’s head

****************

Every team has licensed and experienced mental health professionals on staff and in their facility

They are fully integrated into the team environment

New York sent a memo to all teams today recommending they utilize the full time mental health counselors available to their players, and/or reach out to the Pyschologist at NFL HQ to arrange for expanding their resources

Have heard several former players talk about texts they’ve received from players who have been out of the league XX years and didn’t sleep last night

This messed people up and it’s important to give players an opportunity to talk it out either with a counselor or just sharing with each other

source: I’m a combat veteran who has been managing PTSD for several decades

This stuff doesn’t just magically go away on it’s own

Dominique Foxworth was on Get Up this morning and he was very traumatized and was super harsh on anyone thinking past Hamlin's health.
Yes, I think a lot of people were traumatized by it including fans that were not necessarily rooting for either team.

 

[BassNBrew]

I can't even imagine how the Bills and Bengals teams will be able to prepare for Sunday

Probably the same way the employees at the Park City ski resort that had a co-worker die after a tree fell into a lift did the next day...at least those that decided to work. Of course you mental perspective is likely different when you paycheck put groceries on the table next week.

 

[BassNBrew]

Bobby Phils story. As i recall he died in season but not on the floor.

https://fadeawayworld.net/nba-media/bobby-phills-the-story-of-his-untimely-death-to-his-sons-inspiring-journey-to-make-the-nba

 

[ignatiusjreilly]

Can't remember who posted this Go Long profile of Hamlin from last year upthread, but I finally had a chance to read it and it is fantastic.

One very tiny consolation to this awful story is that Hamlin seems uniquely well suited to overcoming adversity

 

[Terminalxylem]

Agree the bolded is extremely important, but are we sure Hamlin had return of spontaneous circulation in seconds? I was under the impression he required ~10 minutes of CPR.

I am not a medical expert, but my understanding is that as soon as CPR begins that blood flow (and oxygen) to the brain resumes and that is the biggest factor in outcome. I don't know how many minutes of CPR were performed before the AED was used and brought his heart back to regular rhythm, or if that even matters as long as the CPR is pumping the blood manually, but the reports say his heartbeat had resumed on its own before he left the field.

High quality CPR can briefly keep someone alive, but it’s no substitute for the return of spontaneous circulation. Because CPR is seldom performed flawlessly, prolonged resuscitation times are associated with worse outcomes, principally from anoxic brain injury (brain damage from not enough oxygenated blood circulating).

Immediate CPR and access to an AED are part of the best case scenario, but prolonged resuscitation (more than 3-4 minutes) is prognostically bad for full recovery. While rare exceptions occur, hardly anyone survives when resuscitation extends beyond 10 minutes.

Correct me if I am wrong, but has it actually been released that he was in ventricular fibrillation? Probably statistically most likely, but that is one of the assumptions I've been cautioning against.
For all we know, he was in ventricular tachycardia with a low enough blood pressure / faint or no pulse that required CPR to be started. My point is, he may have significant blood flow and oxygen delivery in those 9 minutes. This isn't an asystole case. I've had plenty of cardiac cases in v fib v tach that survived fine with 9 minutes of cpr

You’re absolutely right. Too many unknowns, but if the report of additional resuscitation was required after he left the field, that’s definitely not good.

 

[Terminalxylem]

Agree the bolded is extremely important, but are we sure Hamlin had return of spontaneous circulation in seconds? I was under the impression he required ~10 minutes of CPR.

I am not a medical expert, but my understanding is that as soon as CPR begins that blood flow (and oxygen) to the brain resumes and that is the biggest factor in outcome. I don't know how many minutes of CPR were performed before the AED was used and brought his heart back to regular rhythm, or if that even matters as long as the CPR is pumping the blood manually, but the reports say his heartbeat had resumed on its own before he left the field.

High quality CPR can briefly keep someone alive, but it’s no substitute for the return of spontaneous circulation. Because CPR is seldom performed flawlessly, prolonged resuscitation times are associated with worse outcomes, principally from anoxic brain injury (brain damage from not enough oxygenated blood circulating).

Immediate CPR and access to an AED are part of the best case scenario, but prolonged resuscitation (more than 3-4 minutes) is prognostically bad for full recovery. While rare exceptions occur, hardly anyone survives when resuscitation extends beyond 10 minutes.

Based on what you've heard so far, are you discouraged regarding Hamlin's long-term prognosis?

Too few details, and it’s too early, but requiring mechanical ventilation post-resuscitation isn’t ideal. Sometimes a shock is all it takes. On the other hand, it’s good news they needed to sedate him while on the vent, as it suggests enough functionality to fight the tube in his airway.

My wife has been a nurse for 25 years including multiple years in Neurology. She mentioned she thought Hamlin suffered a neurological event after he collapsed and fell based on his arm movements (blood clot, stoke, etc.). She believes he suffered a brain related injury before the entire CPR process even got started (in addition to potential limited blood flow to the brain risk from the extended CPR). That's just her opinion from watching the replay . . . curious if you had an opinion on that. She fears he's more at risk from the neurological event more than the cardiac event.

I think this scenario is extremely unlikely I've run between 1500-2000 codes and IMO this was cardiac based on the information publicly available and visually. He is surely at risk for a neurological event from anoxia, but I think it is very unlikely that the inciting event was neurological in origin

I don’t know the medical terms, but she said his arms / hands were inverted or twitching either as he fell or just after he had fallen. She said that was a classic sign of a neurological event.

This is just myoclonus that occurs commonly when blood pressure drops suddenly. See it all the time with vasovagal syncope. No prognostic or diagnostic value

Yeah, I considered that, but didn’t see myoclonic jerking.

 

[growlers]

Agree the bolded is extremely important, but are we sure Hamlin had return of spontaneous circulation in seconds? I was under the impression he required ~10 minutes of CPR.

I am not a medical expert, but my understanding is that as soon as CPR begins that blood flow (and oxygen) to the brain resumes and that is the biggest factor in outcome. I don't know how many minutes of CPR were performed before the AED was used and brought his heart back to regular rhythm, or if that even matters as long as the CPR is pumping the blood manually, but the reports say his heartbeat had resumed on its own before he left the field.

High quality CPR can briefly keep someone alive, but it’s no substitute for the return of spontaneous circulation. Because CPR is seldom performed flawlessly, prolonged resuscitation times are associated with worse outcomes, principally from anoxic brain injury (brain damage from not enough oxygenated blood circulating).

Immediate CPR and access to an AED are part of the best case scenario, but prolonged resuscitation (more than 3-4 minutes) is prognostically bad for full recovery. While rare exceptions occur, hardly anyone survives when resuscitation extends beyond 10 minutes.

Based on what you've heard so far, are you discouraged regarding Hamlin's long-term prognosis?

Too few details, and it’s too early, but requiring mechanical ventilation post-resuscitation isn’t ideal. Sometimes a shock is all it takes. On the other hand, it’s good news they needed to sedate him while on the vent, as it suggests enough functionality to fight the tube in his airway.

My wife has been a nurse for 25 years including multiple years in Neurology. She mentioned she thought Hamlin suffered a neurological event after he collapsed and fell based on his arm movements (blood clot, stoke, etc.). She believes he suffered a brain related injury before the entire CPR process even got started (in addition to potential limited blood flow to the brain risk from the extended CPR). That's just her opinion from watching the replay . . . curious if you had an opinion on that. She fears he's more at risk from the neurological event more than the cardiac event.

I think this scenario is extremely unlikely I've run between 1500-2000 codes and IMO this was cardiac based on the information publicly available and visually. He is surely at risk for a neurological event from anoxia, but I think it is very unlikely that the inciting event was neurological in origin

I don’t know the medical terms, but she said his arms / hands were inverted or twitching either as he fell or just after he had fallen. She said that was a classic sign of a neurological event.

This is just myoclonus that occurs commonly when blood pressure drops suddenly. See it all the time with vasovagal syncope. No prognostic or diagnostic value

I appreciate everyone’s contributions, but you sound like you really know your stuff.

Thank you for chiming in.

No problem. I was an NFL UNC for 2 years as well as an ER doc for >20. There is a lot of NFL training we do with the entire sideline team for this exact scenario

Truly appreciate you sharing your perspective (same goes for @Terminalxylem ).

What is the range of outcomes for an event like this? Will there be a point in the next few days/weeks where we can safely say he's out of the woods? Is it possible he has lifelong complications? I believe others have mentioned that Chris Pronger made a full recovery and resumed his career

Range? death to 100% recovery. Not being snarky. Simply too many unknowns for me or anyone else outside the hospital to speculate the outcome. And if he really is in a 48-72 hour hypothermia, likely even they can't tell you as neuro exam is pretty useless in full hypothermia protocol

 

[growlers]

Agree the bolded is extremely important, but are we sure Hamlin had return of spontaneous circulation in seconds? I was under the impression he required ~10 minutes of CPR.

I am not a medical expert, but my understanding is that as soon as CPR begins that blood flow (and oxygen) to the brain resumes and that is the biggest factor in outcome. I don't know how many minutes of CPR were performed before the AED was used and brought his heart back to regular rhythm, or if that even matters as long as the CPR is pumping the blood manually, but the reports say his heartbeat had resumed on its own before he left the field.

High quality CPR can briefly keep someone alive, but it’s no substitute for the return of spontaneous circulation. Because CPR is seldom performed flawlessly, prolonged resuscitation times are associated with worse outcomes, principally from anoxic brain injury (brain damage from not enough oxygenated blood circulating).

Immediate CPR and access to an AED are part of the best case scenario, but prolonged resuscitation (more than 3-4 minutes) is prognostically bad for full recovery. While rare exceptions occur, hardly anyone survives when resuscitation extends beyond 10 minutes.

Based on what you've heard so far, are you discouraged regarding Hamlin's long-term prognosis?

Too few details, and it’s too early, but requiring mechanical ventilation post-resuscitation isn’t ideal. Sometimes a shock is all it takes. On the other hand, it’s good news they needed to sedate him while on the vent, as it suggests enough functionality to fight the tube in his airway.

My wife has been a nurse for 25 years including multiple years in Neurology. She mentioned she thought Hamlin suffered a neurological event after he collapsed and fell based on his arm movements (blood clot, stoke, etc.). She believes he suffered a brain related injury before the entire CPR process even got started (in addition to potential limited blood flow to the brain risk from the extended CPR). That's just her opinion from watching the replay . . . curious if you had an opinion on that. She fears he's more at risk from the neurological event more than the cardiac event.

I think this scenario is extremely unlikely I've run between 1500-2000 codes and IMO this was cardiac based on the information publicly available and visually. He is surely at risk for a neurological event from anoxia, but I think it is very unlikely that the inciting event was neurological in origin

I don’t know the medical terms, but she said his arms / hands were inverted or twitching either as he fell or just after he had fallen. She said that was a classic sign of a neurological event.

This is just myoclonus that occurs commonly when blood pressure drops suddenly. See it all the time with vasovagal syncope. No prognostic or diagnostic value

Yeah, I considered that, but didn’t see myoclonic jerking.

quite a bit of time it manifests as a brief generalized stiffness visually. Then they just go limp. Seen this many many times.

 

[Ministry of Pain]

Not a lot of updates to report, I did put in the thread title that Hamlin remains in ICU

Does anyone know if he has opened his eyes yet?
I'm only asking because I really haven't heard and I think some people might be shocked to hear this
He is on a machine right now, that machine I assume is what is keeping him breathing.

We just have not heard anything positive. We heard that vital signs were retuning late last night but I haven't heard a thing today

 

[BobbyLayne]

I can't even imagine how the Bills and Bengals teams will be able to prepare for Sunday

The Bengals lost Chris Henry and played 3 days later. It sucks but things happen. Not trying to sound like "get over it", if anyone is too affected to play even by Sunday then that is okay for them to not play, but life just goes on for most people.

ETA: And life just goes on does not mean forget about it, it just means that life goes on.

Guys, tragic stuff happens every day. Hundreds or thousands of times every day. We move on. Humans move on. If we didn't move on from tragic things, what the hell would this country look like right now???
It hurts. It sucks. It sucks not knowing. It will hurt regardless of the outcome cause even with a recovery he never plays again IMO.
Moving on isn't just something I hope they do, it's something they NEED to do, that they SHOULD do. The amount of time that takes is FAR from decided. He might recover and be good tomorrow. He might pass away on Saturday which would obviously make playing not possible for the Bills. Who knows.
All I know is they WILL move on, they HAVE to move on, they SHOULD move on.
Fans can/will/should as well.

Quoted a couple but it's just a representative sample. I have seen these sentiments posted and tweeted often in the last 24 hours. IOW not directed at these two posters so much as using these examples to address something important to me. I have direct experience with PTSD.

It's a mother****er.

***************

We all want to move on from trauma. Everyone does. But the part of our brain that is devoted to our survival - the universal fight or flight response we all possess, which lies deep below our rational brain - is simply not great at denial. Long after a traumatic event is over, it might be reactivated ("triggered" in common parlance) by the slightest hint of danger. Your body will involuntarily secrete massive amounts of stress hormones.

Trauma produces actual physiological changes which fundamentally alters us. The increased stress hormones alter the system in our brains which filters relevant information from the irrelevant. Trauma compromises the part of the brain which makes us feel fully alive. Traumatized individuals become hypervigilant to threat - to the point of becoming incapable of spontaneously engaging others in their daily lives. Traumatized people keep repeating the same mistakes and have trouble learning from experience.

Like I said, it's a mother****er.

It isn't matter of willpower or bad character or "not being strong enough to get past it." It's the result of actual changes in the brain.

This is not the best place to take a deep dive into PTSD, but I am hoping what I write will at a minimum help folks reconsider their preconceived ideas about mental health.

*****************

Witnessing a traumatic event but not directly experiencing it can be psychologically quite damaging.

30% of individuals who witness a traumatic event develop post-traumatic stress disorder (PTSD.)

PTSD and Witnessed Medical Emergency

The Mayo Clinic points out that PTSD can be triggered by a terrifying event that is either experienced or witnessed. Therefore, people with PTSD who observe a medical emergency happening to another person may have an extreme reaction even though they are safe. If someone with PTSD watches a loved one endure trauma, then the emotional significance may further incapacitate a PTSD patient.

Symptoms of PTSD

The symptoms of PTSD include the following major categories: intrusive memories, avoidance, negative changes in thinking and mood and changes in emotional reactions. Within these major categories, PTSD sufferers may have the following reactions:

• Negative feelings about themselves or other people
• Feeling emotionally numb
• Memory problems, including forgetting important aspects of the traumatic event
• Irritability, angry outbursts or aggressive behaviour
• Overwhelming guilt or shame
• Self-destructive behaviour, such as drinking too much or driving too fastThese more defined reactions link PTSD to medical emergencies and substance abuse.

PTSD Links to Substance Abuse

The Mayo Clinic states that people with PTSD often suffer in other aspects of life, including employment, relationships, health and enjoyment of everyday activities. Because PTSD causes so many problems, it increases the risks of the following issues:

• Depression and anxiety
• Drug or alcohol use
• Eating disorders
• Suicidal thoughts and actions

When someone with PTSD also experiences depression, anxiety or suicidal thoughts, substance abuse becomes highly likely. In fact, people with PTSD may abuse drugs or alcohol either to numb their feelings or to replace them temporarily with a drug-induced euphoria.

PTSD Links to Medical Emergency

People with PTSD struggle to stay productive. When people have to expend so much time, focus and effort to deal with their symptoms, they are often left weak in body, mind and spirit, which can lead to improper care. For example, someone with a serious lack of focus while driving may drive recklessly, which may cause a medical emergency due to a traffic accident.

Hey, I am as clueless as the next person on how the NFL should proceed from here. Trauma will affect people in different ways. But all NFL players should be evaluated for how this event has affected them.

No one should be advocating let's just get over it and move on.

One thing that will likely help the players (if the NFL and teams handle this properly) is this is a shared experience. Often times, PTSD arises from events which are taboo to discuss (i.e., killing Afghani children suspected of planting an IED.) Collective trauma like 9/11 or the Coronavirus pandemic are shared experiences that people are willing to be open about without feeling shame or remorse.

But this is affecting every NFL player rn. And though our inclination is to suppose that is most acute with the Bengals and Bills who were a few feet away from their comrade fighting for his life, my ear noticed today that players far away, with no connection to either team, were deeply affected. Nobody thinks about mortality when they are 24. Everyone is aware of the risks of common injuries like torn ligaments or brain trauma. But life/death emergency on the field. Yeah, that's not something any of the players had considered.

We're getting better about being open minded about the importance of mental health. But often when the rubber meets the road, I'm reminded also not really.

The NFL has a tremendous opportunity right now to take the lead and reframe the importance of making space for effective mental health treatment. Like seriously, they could change the national conversation if they go about this in a deliberate and sensitive manner.

 

[Ministry of Pain]

His uncle has released a statement or shared some information
The Uncle says he is showing signs of improvement, I'll trust the uncle tonight and not ask a lot of questions
Just wait for him to hopefully make it out of ICU
Uncle shared he is on a ventilator right now
Think it was on CBS

 

[ignatiusjreilly]

Agree the bolded is extremely important, but are we sure Hamlin had return of spontaneous circulation in seconds? I was under the impression he required ~10 minutes of CPR.

I am not a medical expert, but my understanding is that as soon as CPR begins that blood flow (and oxygen) to the brain resumes and that is the biggest factor in outcome. I don't know how many minutes of CPR were performed before the AED was used and brought his heart back to regular rhythm, or if that even matters as long as the CPR is pumping the blood manually, but the reports say his heartbeat had resumed on its own before he left the field.

High quality CPR can briefly keep someone alive, but it’s no substitute for the return of spontaneous circulation. Because CPR is seldom performed flawlessly, prolonged resuscitation times are associated with worse outcomes, principally from anoxic brain injury (brain damage from not enough oxygenated blood circulating).

Immediate CPR and access to an AED are part of the best case scenario, but prolonged resuscitation (more than 3-4 minutes) is prognostically bad for full recovery. While rare exceptions occur, hardly anyone survives when resuscitation extends beyond 10 minutes.

Based on what you've heard so far, are you discouraged regarding Hamlin's long-term prognosis?

Too few details, and it’s too early, but requiring mechanical ventilation post-resuscitation isn’t ideal. Sometimes a shock is all it takes. On the other hand, it’s good news they needed to sedate him while on the vent, as it suggests enough functionality to fight the tube in his airway.

My wife has been a nurse for 25 years including multiple years in Neurology. She mentioned she thought Hamlin suffered a neurological event after he collapsed and fell based on his arm movements (blood clot, stoke, etc.). She believes he suffered a brain related injury before the entire CPR process even got started (in addition to potential limited blood flow to the brain risk from the extended CPR). That's just her opinion from watching the replay . . . curious if you had an opinion on that. She fears he's more at risk from the neurological event more than the cardiac event.

I think this scenario is extremely unlikely I've run between 1500-2000 codes and IMO this was cardiac based on the information publicly available and visually. He is surely at risk for a neurological event from anoxia, but I think it is very unlikely that the inciting event was neurological in origin

I don’t know the medical terms, but she said his arms / hands were inverted or twitching either as he fell or just after he had fallen. She said that was a classic sign of a neurological event.

This is just myoclonus that occurs commonly when blood pressure drops suddenly. See it all the time with vasovagal syncope. No prognostic or diagnostic value

I appreciate everyone’s contributions, but you sound like you really know your stuff.

Thank you for chiming in.

No problem. I was an NFL UNC for 2 years as well as an ER doc for >20. There is a lot of NFL training we do with the entire sideline team for this exact scenario

Truly appreciate you sharing your perspective (same goes for @Terminalxylem ).

What is the range of outcomes for an event like this? Will there be a point in the next few days/weeks where we can safely say he's out of the woods? Is it possible he has lifelong complications? I believe others have mentioned that Chris Pronger made a full recovery and resumed his career

Range? death to 100% recovery. Not being snarky. Simply too many unknowns for me or anyone else outside the hospital to speculate the outcome. And if he really is in a 48-72 hour hypothermia, likely even they can't tell you as neuro exam is pretty useless in full hypothermia protocol

Yeah, I kinda figured you'd say that

Let me try a different angle: What should we look for over the next few days? Obviously positive reports. What would be a good thing to hear once he's out of the hypothermia protocol?

Again, appreciate you sharing your insights.

 

[growlers]

Agree the bolded is extremely important, but are we sure Hamlin had return of spontaneous circulation in seconds? I was under the impression he required ~10 minutes of CPR.

I am not a medical expert, but my understanding is that as soon as CPR begins that blood flow (and oxygen) to the brain resumes and that is the biggest factor in outcome. I don't know how many minutes of CPR were performed before the AED was used and brought his heart back to regular rhythm, or if that even matters as long as the CPR is pumping the blood manually, but the reports say his heartbeat had resumed on its own before he left the field.

High quality CPR can briefly keep someone alive, but it’s no substitute for the return of spontaneous circulation. Because CPR is seldom performed flawlessly, prolonged resuscitation times are associated with worse outcomes, principally from anoxic brain injury (brain damage from not enough oxygenated blood circulating).

Immediate CPR and access to an AED are part of the best case scenario, but prolonged resuscitation (more than 3-4 minutes) is prognostically bad for full recovery. While rare exceptions occur, hardly anyone survives when resuscitation extends beyond 10 minutes.

Based on what you've heard so far, are you discouraged regarding Hamlin's long-term prognosis?

Too few details, and it’s too early, but requiring mechanical ventilation post-resuscitation isn’t ideal. Sometimes a shock is all it takes. On the other hand, it’s good news they needed to sedate him while on the vent, as it suggests enough functionality to fight the tube in his airway.

My wife has been a nurse for 25 years including multiple years in Neurology. She mentioned she thought Hamlin suffered a neurological event after he collapsed and fell based on his arm movements (blood clot, stoke, etc.). She believes he suffered a brain related injury before the entire CPR process even got started (in addition to potential limited blood flow to the brain risk from the extended CPR). That's just her opinion from watching the replay . . . curious if you had an opinion on that. She fears he's more at risk from the neurological event more than the cardiac event.

I think this scenario is extremely unlikely I've run between 1500-2000 codes and IMO this was cardiac based on the information publicly available and visually. He is surely at risk for a neurological event from anoxia, but I think it is very unlikely that the inciting event was neurological in origin

I don’t know the medical terms, but she said his arms / hands were inverted or twitching either as he fell or just after he had fallen. She said that was a classic sign of a neurological event.

This is just myoclonus that occurs commonly when blood pressure drops suddenly. See it all the time with vasovagal syncope. No prognostic or diagnostic value

I appreciate everyone’s contributions, but you sound like you really know your stuff.

Thank you for chiming in.

No problem. I was an NFL UNC for 2 years as well as an ER doc for >20. There is a lot of NFL training we do with the entire sideline team for this exact scenario

Truly appreciate you sharing your perspective (same goes for @Terminalxylem ).

What is the range of outcomes for an event like this? Will there be a point in the next few days/weeks where we can safely say he's out of the woods? Is it possible he has lifelong complications? I believe others have mentioned that Chris Pronger made a full recovery and resumed his career

Range? death to 100% recovery. Not being snarky. Simply too many unknowns for me or anyone else outside the hospital to speculate the outcome. And if he really is in a 48-72 hour hypothermia, likely even they can't tell you as neuro exam is pretty useless in full hypothermia protocol

Yeah, I kinda figured you'd say that

Let me try a different angle: What should we look for over the next few days? Obviously positive reports. What would be a good thing to hear once he's out of the hypothermia protocol?

Again, appreciate you sharing your insights.

Well, i don't know for sure they did hypothermia. It's been reported but who knows where that came from. It was all the rage for awhile after some promising studies but some later studies out of europe made a lot of centers stop doing it nearly as much.
if they can extubate him soon, that's probably the best sign. That would mean he is at least reasonably intact neurologically. Can't do that until hypothermia protocol ends if they are doing it.
Also, they will likely do an EP study as I mentioned earlier. Would maybe do that while he is still on the vent and place an AICD if indicated

 

[Terminalxylem]

Agree the bolded is extremely important, but are we sure Hamlin had return of spontaneous circulation in seconds? I was under the impression he required ~10 minutes of CPR.

I am not a medical expert, but my understanding is that as soon as CPR begins that blood flow (and oxygen) to the brain resumes and that is the biggest factor in outcome. I don't know how many minutes of CPR were performed before the AED was used and brought his heart back to regular rhythm, or if that even matters as long as the CPR is pumping the blood manually, but the reports say his heartbeat had resumed on its own before he left the field.

High quality CPR can briefly keep someone alive, but it’s no substitute for the return of spontaneous circulation. Because CPR is seldom performed flawlessly, prolonged resuscitation times are associated with worse outcomes, principally from anoxic brain injury (brain damage from not enough oxygenated blood circulating).

Immediate CPR and access to an AED are part of the best case scenario, but prolonged resuscitation (more than 3-4 minutes) is prognostically bad for full recovery. While rare exceptions occur, hardly anyone survives when resuscitation extends beyond 10 minutes.

Based on what you've heard so far, are you discouraged regarding Hamlin's long-term prognosis?

Too few details, and it’s too early, but requiring mechanical ventilation post-resuscitation isn’t ideal. Sometimes a shock is all it takes. On the other hand, it’s good news they needed to sedate him while on the vent, as it suggests enough functionality to fight the tube in his airway.

My wife has been a nurse for 25 years including multiple years in Neurology. She mentioned she thought Hamlin suffered a neurological event after he collapsed and fell based on his arm movements (blood clot, stoke, etc.). She believes he suffered a brain related injury before the entire CPR process even got started (in addition to potential limited blood flow to the brain risk from the extended CPR). That's just her opinion from watching the replay . . . curious if you had an opinion on that. She fears he's more at risk from the neurological event more than the cardiac event.

I think this scenario is extremely unlikely I've run between 1500-2000 codes and IMO this was cardiac based on the information publicly available and visually. He is surely at risk for a neurological event from anoxia, but I think it is very unlikely that the inciting event was neurological in origin

I don’t know the medical terms, but she said his arms / hands were inverted or twitching either as he fell or just after he had fallen. She said that was a classic sign of a neurological event.

This is just myoclonus that occurs commonly when blood pressure drops suddenly. See it all the time with vasovagal syncope. No prognostic or diagnostic value

I appreciate everyone’s contributions, but you sound like you really know your stuff.

Thank you for chiming in.

No problem. I was an NFL UNC for 2 years as well as an ER doc for >20. There is a lot of NFL training we do with the entire sideline team for this exact scenario

Truly appreciate you sharing your perspective (same goes for @Terminalxylem ).

What is the range of outcomes for an event like this? Will there be a point in the next few days/weeks where we can safely say he's out of the woods? Is it possible he has lifelong complications? I believe others have mentioned that Chris Pronger made a full recovery and resumed his career

Range? death to 100% recovery. Not being snarky. Simply too many unknowns for me or anyone else outside the hospital to speculate the outcome. And if he really is in a 48-72 hour hypothermia, likely even they can't tell you as neuro exam is pretty useless in full hypothermia protocol

 

[culdeus]

Maybe an obvious question/answer but I assume they can't tell if someone is brain dead at this point? Or is this ruled out?

 

[growlers]

Maybe an obvious question/answer but I assume they can't tell if someone is brain dead at this point? Or is this ruled out?

without getting into specifics medically, the only way this would happen if he was anoxic long enough to have brain edema eventually causing brain death, and that almost certainly wouldn't have occurred by now based on the timetable. It is a longer process than this, 72 hours minimum. Also can't assess until hypothermia protocol over if they are doing it.
Based upon publicly released information, seems unlikely to be on the table as a possibility at this point

 

[ignatiusjreilly]

https://twitter.com/ColeyHarvey/status/1610424632485773312?s=20&t=1vxxtzf7LDQgpMX1eUxyVA

Glenn said his nephew had to be resuscitated twice. Once on the field at Paycor Stadium, once after he arrived at the hospital. There is a concern of lung damage, Glenn said.

 

[ignatiusjreilly]

https://twitter.com/4JoshReed/status/1610422377652838401

Just spoke with Damar Hamlin’s uncle. Damar was originally on 100% oxygen and is now down to 50%. Says the family is hanging in there. He thanked Bills fans, and Bengals fans and asked for continued prayers

Interesting that this tweet and the one above, presumably citing the same uncle, were posted nine minutes apart. This one sounds more optimistic, the other less so

 

[The Duff Man]

One of the things that goes along with this event being unprecedented is that there are no good analogies to guide how things moved forward following similar events.

A lot of the ones posted in this thread are way off the mark.

 

[(HULK)]

I can't even imagine how the Bills and Bengals teams will be able to prepare for Sunday

The Bengals lost Chris Henry and played 3 days later. It sucks but things happen. Not trying to sound like "get over it", if anyone is too affected to play even by Sunday then that is okay for them to not play, but life just goes on for most people.

ETA: And life just goes on does not mean forget about it, it just means that life goes on.

It's one thing to lose someone you're close to and another thing to watch them die. Wildly different trauma IMO

 

[(HULK)]

Agree the bolded is extremely important, but are we sure Hamlin had return of spontaneous circulation in seconds? I was under the impression he required ~10 minutes of CPR.

I am not a medical expert, but my understanding is that as soon as CPR begins that blood flow (and oxygen) to the brain resumes and that is the biggest factor in outcome. I don't know how many minutes of CPR were performed before the AED was used and brought his heart back to regular rhythm, or if that even matters as long as the CPR is pumping the blood manually, but the reports say his heartbeat had resumed on its own before he left the field.

High quality CPR can briefly keep someone alive, but it’s no substitute for the return of spontaneous circulation. Because CPR is seldom performed flawlessly, prolonged resuscitation times are associated with worse outcomes, principally from anoxic brain injury (brain damage from not enough oxygenated blood circulating).

Immediate CPR and access to an AED are part of the best case scenario, but prolonged resuscitation (more than 3-4 minutes) is prognostically bad for full recovery. While rare exceptions occur, hardly anyone survives when resuscitation extends beyond 10 minutes.

Correct me if I am wrong, but has it actually been released that he was in ventricular fibrillation? Probably statistically most likely, but that is one of the assumptions I've been cautioning against.
For all we know, he was in ventricular tachycardia with a low enough blood pressure / faint or no pulse that required CPR to be started. My point is, he may have significant blood flow and oxygen delivery in those 9 minutes. This isn't an asystole case. I've had plenty of cardiac cases in v fib v tach that survived fine with 9 minutes of cpr

I don’t think any of that info has been released. The only new info is from ESPN’s Coley Harvey reporting that Hamlin’s uncle told him that Hamlin has to be revived a 2nd time after he got to the hospital and that there is concern of lung damage. He also said that they had started Hamlin on 100% oxygen when he first got there but is down to 50% oxygen now.

it is quite common for someone who collapses from a cardiac rhythm issue to have another occurrence. And "lung damage" description may have gone from RN to uncle to EPSN reporter to being reported. Maybe he aspirated a little, maybe he has a pulmonary contusion from the CPR, etc. I wouldn't read anything into any of this stuff at this point, its just noise.

If he doesn't have a pulmonary contusion I'd be worried about brain damage. You need to pump that chest hard AF to move blood to the brain.

 

[ignatiusjreilly]

I can't even imagine how the Bills and Bengals teams will be able to prepare for Sunday

The Bengals lost Chris Henry and played 3 days later. It sucks but things happen. Not trying to sound like "get over it", if anyone is too affected to play even by Sunday then that is okay for them to not play, but life just goes on for most people.

ETA: And life just goes on does not mean forget about it, it just means that life goes on.

It's one thing to lose someone you're close to and another thing to watch them die. Wildly different trauma IMO

In retrospect, it's amazing that the Chiefs played the day after their coach and GM watched Jovan Belcher shoot himself in the stadium parking lot. Maybe I'm misremembering, but I don't even recall any discussions about postponing the game

 

[culdeus]

I can't even imagine how the Bills and Bengals teams will be able to prepare for Sunday

The Bengals lost Chris Henry and played 3 days later. It sucks but things happen. Not trying to sound like "get over it", if anyone is too affected to play even by Sunday then that is okay for them to not play, but life just goes on for most people.

ETA: And life just goes on does not mean forget about it, it just means that life goes on.

It's one thing to lose someone you're close to and another thing to watch them die. Wildly different trauma IMO

In retrospect, it's amazing that the Chiefs played the day after their coach and GM watched Jovan Belcher shoot himself in the stadium parking lot. Maybe I'm misremembering, but I don't even recall any discussions about postponing the game

Slightly different. Playing that game honored his victim even if you assign some fault to mental health.

 

[growlers]

Agree the bolded is extremely important, but are we sure Hamlin had return of spontaneous circulation in seconds? I was under the impression he required ~10 minutes of CPR.

I am not a medical expert, but my understanding is that as soon as CPR begins that blood flow (and oxygen) to the brain resumes and that is the biggest factor in outcome. I don't know how many minutes of CPR were performed before the AED was used and brought his heart back to regular rhythm, or if that even matters as long as the CPR is pumping the blood manually, but the reports say his heartbeat had resumed on its own before he left the field.

High quality CPR can briefly keep someone alive, but it’s no substitute for the return of spontaneous circulation. Because CPR is seldom performed flawlessly, prolonged resuscitation times are associated with worse outcomes, principally from anoxic brain injury (brain damage from not enough oxygenated blood circulating).

Immediate CPR and access to an AED are part of the best case scenario, but prolonged resuscitation (more than 3-4 minutes) is prognostically bad for full recovery. While rare exceptions occur, hardly anyone survives when resuscitation extends beyond 10 minutes.

Correct me if I am wrong, but has it actually been released that he was in ventricular fibrillation? Probably statistically most likely, but that is one of the assumptions I've been cautioning against.
For all we know, he was in ventricular tachycardia with a low enough blood pressure / faint or no pulse that required CPR to be started. My point is, he may have significant blood flow and oxygen delivery in those 9 minutes. This isn't an asystole case. I've had plenty of cardiac cases in v fib v tach that survived fine with 9 minutes of cpr

I don’t think any of that info has been released. The only new info is from ESPN’s Coley Harvey reporting that Hamlin’s uncle told him that Hamlin has to be revived a 2nd time after he got to the hospital and that there is concern of lung damage. He also said that they had started Hamlin on 100% oxygen when he first got there but is down to 50% oxygen now.

it is quite common for someone who collapses from a cardiac rhythm issue to have another occurrence. And "lung damage" description may have gone from RN to uncle to EPSN reporter to being reported. Maybe he aspirated a little, maybe he has a pulmonary contusion from the CPR, etc. I wouldn't read anything into any of this stuff at this point, its just noise.

If he doesn't have a pulmonary contusion I'd be worried about brain damage. You need to pump that chest hard AF to move blood to the brain.

i can't give you a % stat or anything but in my experience pulmonary contusions visible on imaging are not routine after CPR. Also, for various reasons people often have abnormal xrays after an arrest, so it would be hard to say some particular spot is a contusion vs something else unless maybe there was an overlying rib fracture visible. I could spit out two dozen reasons why a family member would be told there was some "lung damage"

 

[encaitar]

I can't even imagine how the Bills and Bengals teams will be able to prepare for Sunday

The Bengals lost Chris Henry and played 3 days later. It sucks but things happen. Not trying to sound like "get over it", if anyone is too affected to play even by Sunday then that is okay for them to not play, but life just goes on for most people.

ETA: And life just goes on does not mean forget about it, it just means that life goes on.

It's one thing to lose someone you're close to and another thing to watch them die. Wildly different trauma IMO

This is really true.

I lost one of my best friends in my early 20s. Literally a guy I hung out with almost every day.(He lived two apartments over and worked at the same place as me) He was in a car accident and died on the scene. It was devastating, but after grieving I got over it and remembered him for the good times we had. Still think about him and wish he were around, but fond memories not devastated hurt.

We had a buddy that was an EMT. Not a real close friend, but someone who we'd hang out with if we saw him at the bar or at some event etc., but not someone who we'd make specific plans to hang with. He was one of the guys on the call for the accident. Was there when our buddy died. It took him years to get over it. He quit being an EMT, had a struggle with alcohol for a number of years. That affected him hugely. I can only assume that the difference was in witnessing our friend die versus just hearing about it.

 

[Penguin]

Did the FFPC make any official ruling, I see folks all over Twitter losing their mind but no official communication from FFPC

 

[Penguin]

Did the FFPC make any official ruling, I see folks all over Twitter losing their mind but no official communication from FFPC

I guess I should expect that on Twitter

 

[Hot Sauce Guy]

I see folks all over Twitter losing their mind

Welcome to twitter. lol

 

[menobrown]

Did the FFPC make any official ruling, I see folks all over Twitter losing their mind but no official communication from FFPC

It's on twitter and you probably got an email.

Their ruling makes no sense. They are saying stats from the game count "as is" and will count so long as the stats are not deleted. The issue is there are no stat corrections or deletions to be made because the NFL at this time is not recognizing any stats from that game. So you can't correct or delete what does not exist. If you look now, if you look in 2 weeks, 2 months or 2 years from now no stats from that game will ever appear. UNLESS, the slim chance the game is made up at a later date in which case the rest of the stats for the game won't count because they will have been accrued to late. Got it? To top it off they are saying this is all official Friday so if the game is not officially terminated for good they are going to contend the stats for the game count even though if they never finish the game and the stats will never officially exist.