Hi Mr. Kirsch. Thank you for your comment. I follow your posts and greatly respect your dogged pursuit of the truth! The reality is that if an individual is in v. fib. and is shocked/defibrillated successfully, they might very well go back into v. fib. spontaneously in the next seconds/minutes. The point being that the heart is really not functioning normally again even though the heart was converted back into a sinus rhythm. The primary issue is that the cells of the sinoatrial node (put out the pacemaking beat or like the drill instructor calling out the cadence for the marching trainees) are not functioning normally and putting out the normal signal. All of the heart tissue--SA and AV nodes, bundle branches, purkinje fibers, muscle cells--spontaneously depolarize and it is the depolarization of the muscle cells that causes them to contract. If the SA node fibers are not sending out the signal on time, every time, the ventricular muscle cells will depolarize first and that location of depolarization in the ventricles, one side or the other, spreads like a run of dominos going down. The result is the ventricles contracting at abnormal rates and asynchronistically so that the ventricles do not push out the blood in them into the lungs on the right side and the head/body/extremities on the left side. That is like a team of work horses or dogs attached to a sled that only one or two of the entire team choose to work at the same time or same effort. They cannot pull like they would if everyone worked together. Defibrillating the heart causes all of the heart tissue (as listed above) to rapidly depolarize and contract at the same instant. All of the heart tissue then repolarize normally effectively at a similar rate. Because the SA node and AV node cells always depolarize faster than the ventricular muscle cells, if the SA node and AV node start producing/transmitting a normal signal down the pathway, the signal will get to the ventricular muscle cells to depolarize them and cause them to contract all at the same time. The simultaneous contraction of the ventricle cells is what produces the effective contraction. Remember a tug-of-war team can only win if everyone pulls together. The patient maybe back in sinus for the moment but can revert to v. fib. because the intrinsic subcellular process of failure by the cells of the pacemaking structures (SA node/AV node/bundle fibers clearly has not been "fixed" permanently. If the SA node cells again fail to send out a regular beat in a sinus rhythem meaning 60-100 for an adult, the ventricular tissue will begin once again to spontaneously depolarize and contract irregularly across the heart muscle at a rate of 30-40 but without force because the entire muscle does not contract together. Those early minutes to hours after an episode of v. fib. are fraught with the potential to degrade once again. You will continue the CPR (meaning the external compressions and, hopefully, pushing oxygen into the lungs) until the patient is spontaneously breathing as well as a palpable pulse can be felt in the wrist. That sensation is usually present with a systolic pressure of around 80mm of Hg which supports life. That was the reason why the CPR was continued a full 9 minutes.

Studies have shown that excellent/textbook CPR can only produce about 20% of normal cardiac output. This means that out in the field, lying on a playing surface, utilizing folks that maybe or may not be practiced/effective CPR givers, will likely produce less than 20% of normal output. It is easy to understand then that having to have CPR for 9 minutes logically suggests that the brain has been in a major deficit for all of that time and the likelihood of having retained significant function is very reduced. Personally and I am not an expert by any means, my concern is that at best, Hamlin will eventually awaken to some degree with a major neurological deficit. At worst, he will be kept intubated and ventilated for several days to 11-12 days. At some point studies looking for blood flow and also brain function will be done. If there is no significant uptake of oxygen by the brain, no response to stimuli and no motor activity (ie. patient is dead) the physicians will be forced to suggest that the resuscitative efforts be terminated and Hamlin's body be allowed to proceed to continue to function on its own or for breathing to stop and then shortly the heart to stop beating . A very dismal outlook. I am NOT an expert but that is my experience of working codes over the years and seeing the results. I hope my assessment proves to be extremely pessimistic and Hamlin's family gets a reasonably normally functioning young man back!!