Rapid CPR saves life of Penn physician who studies heart disease

A day after his heart stopped beating, causing him to black out and fall sideways into the arms of a dinner companion, Kevin Volpp was alive and alert, peppering his doctors with questions.

He knew better than most that his odds had been grim. A prominent health-policy researcher at the University of Pennsylvania’s Perelman School of Medicine, Volpp had coauthored 150 papers on the very topic that landed him in a Cincinnati hospital bed: heart disease.

So when cardiologist David M. Harris told Volpp he must have received prompt, high-quality CPR before being taken to the hospital July 9, the bedridden researcher wanted proof.

“How do you know I received high-quality CPR?” Volpp asked.

“Because,” his doctor replied, “I’m talking to you 24 hours after the event.”

Volpp, 54, shared his story of survival at an American Heart Association conference Monday, in hopes that more people who experience a sudden cardiac arrest will fare as well as he did.

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The rapid CPR — performed by Drexel University squash coach John White, who had joined Volpp in Cincinnati to watch his daughter play in a tournament — was just one of many factors contributing to the happy ending. Also essential was the fast action by paramedics, who were on the scene in five minutes with a defibrillator, followed by quick action at the hospital to address the root cause: a 99% blockage in one of Volpp’s coronary arteries.

In addition, Volpp’s physicians said, he benefited from preventive measures that were years in the making.

The director of Penn’s Center for Health Incentives and Behavioral Economics, Volpp has spent much of his career studying strategies to promote heart-healthy behaviors, and he also practices them himself. He eats a balanced diet, does not smoke, and exercises regularly.

In the four months leading up to his cardiac arrest, he ramped up his activity level considerably, training with daughter Anna for an Ironman 70.3 triathlon (also called a half Ironman, with a 1.2 mile swim, a 56-mile bike ride, and a 13.1-mile run).

The pair successfully completed a shorter triathlon in June, and were looking forward to the half Ironman in late July.

“I was probably in the best shape I’d been in since I was 25 years old,” he said.

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Yet his family history worked against him. Volpp’s father, Gert, had suffered a heart attack at age 55.

So when Volpp turned 50, his doctor urged him to undergo a test called a coronary CT scan. Sure enough, his arteries appeared to be lined with significant amounts of calcified plaque, and Volpp began taking a daily aspirin and cholesterol-lowering statin.

He continued to exercise, and all seemed well until four years later, at the July 9 dinner in Cincinnati.

Volpp was there to watch 15-year-old daughter Daphne in a squash tournament. The pair went to a restaurant that night with her coach, Gina Stoker of the Cynwyd Club, and White, Stoker’s boyfriend, along with some friends.

As he started to chew his first bite of food, Volpp reached for his water but knocked it over. He slumped to the table, then fell sideways into White’s arms.

Stoker immediately called 911. White placed Volpp on the floor, rolled him on his side, and checked his airway to make sure it was clear.

Volpp had no pulse and was not breathing, so White began CPR: sets of 30 chest compressions followed by two quick breaths of mouth-to-mouth resuscitation. (A simpler procedure without the breaths, called hands-only CPR, also is effective.)

He kept it up for four minutes until police and paramedics arrived and took over. Volpp had no pulse for 14 minutes, needing three shocks from the defibrillator, so the CPR was essential for circulating his blood in the meantime. (The restaurant did not have a defibrillator, Volpp was dismayed to learn later, despite being part of a large national chain.)

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Told that the Cincinnati doctors had judged his CPR technique to be “high-quality,” White attributed it to the training he got at Drexel. Coaches and athletic staff must be certified in the lifesaving technique every two years, he said.

“When you’re seeing somebody on the floor, you go through all the training that you’ve done. You think ‘Are you doing it right?’ ” he said. “Everything’s going a million miles an hour.”

Proper CPR technique involves compressing the chest at a rate of 100 to 120 times per minute — roughly the same beat as the Bee Gee’s song “Stayin’ Alive.” And the compressions must be fairly vigorous — more so than many people realize until they undergo training.

Afterward, Volpp said his chest felt sore, a sign that White was doing it right.

At the hospital, tests would reveal that Volpp had suffered a heart attack, meaning that plaque had ruptured in a coronary artery, leading to the blockage.

In most heart attacks, the organ continues to pump. But in Volpp’s case, the blockage triggered an electrical shutdown: a sudden cardiac arrest. When such events happen outside the hospital, death occurs in nine out of 10 cases. And those who do survive often have cognitive impairment or other disability.

Not Volpp. Physicians inserted a slender balloon to prop open the diseased artery just 68 minutes after Volpp reached the University of Cincinnati Medical Center — well within the 90-minute “door-to-balloon time” that is considered an industry standard.

Volpp says he feels great, with no apparent long-term complications. While he could not join Anna in the half Ironman on July 25, he now has resumed moderate-intensity exercise for 45 to 60 minutes a day — a mixture of biking, running, swimming, and rowing.

He has been back at work since September, resuming his study of how to promote heart-healthy behavior. On top of his years of research, he now can add a data point from his personal experience.