Ryan Jones does not remember skidding in the snow on May 20, 2016 in Fort St. John causing his chest to slam into the steering wheel and sending him into cardiac arrest.
sa国际传媒淢y first memory was waking up in GF Strong [Rehabilitation Centre] in Vancouver five-and-a-half months later,sa国际传媒� Ryan told Black Press Media.
Now, the 25-year-old Smithers man is at the forefront of a new medical intervention that could save countless lives.
Dr. Mypinder Sekhon, who was a member of the team that treated Ryan at Vancouver General Hospital when he first arrived via air ambulance in the Lower Mainland, said the prognosis was bleak from the start.
sa国际传媒淚n Ryansa国际传媒檚 case, every textbook and every prognostication would have told you we should stop the life support, that he was going to have a dismal outcome,sa国际传媒� Sekhon said during an interview by telephone.
A life and death decision
At the time of Ryansa国际传媒檚 accident, Vancouver General had been using a technique called autoregulation monitoring (ARM) for approximately eight months to customize treatments for victims of traumatic head injuries. The procedure involves placing catheters in a patientsa国际传媒檚 brain using an apparatus called a Brain Bolt, which provides critical information that gives the medical team an opportunity to limit or even reverse brain damage, Sekhon explained.
It had never been tried, anywhere, in a cardiac arrest case.
sa国际传媒淩yan sustained a pretty long cardiac arrest,sa国际传媒� Sekhon said. sa国际传媒淗is heart had stopped for quite some time and even after it had been restarted his body wasnsa国际传媒檛 getting enough oxygen and his brain wasnsa国际传媒檛 getting enough blood flow. Wesa国际传媒檝e been using this technology of the Brain Bolt in brain injuries that result from trauma, so when Ryan came to Vancouver General, the CT scan suggested what we feared, that the brain had been damaged and we had never undertaken this type of procedure or monitoring in a cardiac arrest patient.sa国际传媒�
It was Sekhonsa国际传媒檚 colleague, Dr. Don Griesdale, who came up with the idea.
sa国际传媒淎dmittedly, it hadnsa国际传媒檛 crossed my mind before, so we didnsa国际传媒檛 really have much to lose at that point given how severe Ryan was,sa国际传媒� Sekhon said.
But ethically, it was not a decision for the doctors to make, so they took it to Ryansa国际传媒檚 parents, Donna and Jim Jones.
sa国际传媒淲e were upfront with them, we were not sure it was going to work in his case,sa国际传媒� Sekhon said.
Fortunately for Ryan, his parents were of the same mind as the medical team.
sa国际传媒淥ur thought at the time was, we donsa国际传媒檛 know if this is going to help Ryan, but if it can be part of research that helps other people in the future then absolutely go ahead,sa国际传媒� Donna recalled. sa国际传媒淭hatsa国际传媒檚 what we said to the doctors.sa国际传媒�
A life-saving intervention
While the hospital had had some success with head trauma patients, they were treading on new ground with Ryan.
sa国际传媒淲e didnsa国际传媒檛 know what we were going to find when we put the catheters in his brain,sa国际传媒� Sekhon said. sa国际传媒淲hat we found was the oxygen levels were very low, but more than that we established that once we actually augmented his heart function, augmented the lung function, that we were able to increase and normalize the oxygen levels in his brain.
sa国际传媒淲hen he had a great outcome, we started thinking, sa国际传媒榳ell, can we start to use this in other cardiac arrest patients and can we study it?sa国际传媒�
They did, and the resulting paper has now been published in the May 2019 edition of Critical Care Medicinesa国际传媒攖he official journal of the Illinois-based Society of Critical Care Medicine.
sa国际传媒淲esa国际传媒檝e done it in about 15 people now in the last year and a bit,sa国际传媒� Sekhon said. sa国际传媒淓ight of them have survived to full recovery. Seven have still died, so a bit better than 50 per cent.
Sekhon acknowledges it is a far cry from a definitive study, but views the results as very promising.
sa国际传媒淭hese numbers are really, really small, so itsa国际传媒檚 hard to draw any really meaningful conclusions about it, but traditionally the good outcome rate, good being full recovery, is in the single digits, or the high teens,sa国际传媒� he explained.
The research shows some potentially ground-breaking results.
sa国际传媒淭he old dogma has been that in cardiac arrest the [brain] injury that you get is dependent upon the initial time at which the heart is stopped and then after restarting the heart, itsa国际传媒檚 not modifiable,sa国际传媒� Sekhon noted.
sa国际传媒淪econdly, traditional thinking has been wesa国际传媒檙e not able to heal the brain by getting adequate oxygen delivery to the brain and so forth.
sa国际传媒淲hat we found was, by changing various interventions, we are able to increase oxygen levels in the brain after resuscitating somebody, after restarting the heart, so that tells us that the brain is, in fact, not dead and the injury is likely modifiable.
sa国际传媒淪econdly the study demonstrated that currently how international guidelines recommend that we treat people is with a cookie cutter approach. Everybody gets the same management.
sa国际传媒淲hat wesa国际传媒檝e found is theresa国际传媒檚 tremendous differences within patients, in how their management differs, or how the brain injury is different, so instead of a one-size-fits all approach, we ought to move towards individualizing the care, or personalizing the medicine.sa国际传媒�
The papersa国际传媒檚 authors will soon be taking their findings on the road to disseminate the information to other hospitals around British Columbia, Sekhon said.
A long road to recovery
It has been almost three years since that fateful day, and Ryan Jones has been in rehabilitation pretty much ever since.
From November 2017 to February of this year, he was in treatment at the Watson Centre for Brain Health in Burnaby. Donna said the program there sa国际传媒渉elped a ton.sa国际传媒�
sa国际传媒淭he brain is so amazing how it can retrain itself,sa国际传媒� she said.
sa国际传媒淗esa国际传媒檚 pretty good, I wouldnsa国际传媒檛 say hesa国际传媒檚 100 per cent back to how he was before the accident, but hesa国际传媒檚 getting very close and hesa国际传媒檚 making improvements still, theysa国际传媒檙e just not as noticeable as they were when he first started into the recovery phase of it.
sa国际传媒淗e has a tough time with a lot of stuff, but no more than anyone else that has a tough time dealing with stuff, he just has a bit of a disadvantage over someone whosa国际传媒檚 never had a brain injury, because brain injuries are funny things and everybody reacts differently with the symptoms.sa国际传媒�
Physically, Ryan is back to his normal self, he said, playing sports and doing pretty much all the things he did before the accident.
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Mentally, he is a work in progress.
sa国际传媒淚sa国际传媒檒l always have issues, Isa国际传媒檓 sure,sa国际传媒� he said. sa国际传媒淭he problems for me are definitely memory in general, short- and long-term memory.
sa国际传媒淢y really, really long-term memory is done for. The only time I have my long-term memory recalls is when Isa国际传媒檓 going to Facebook and looking up old photos and stuff like that. Other times when I have memory recalls is when someone will mention a story and, not a hundred per cent clearly, but I will somewhat recognize what theysa国际传媒檙e generally talking about so itsa国际传媒檚 not a full memory, but Isa国际传媒檝e got the idea of it.sa国际传媒�
An undying gratitude
Ultimately, Ryan and his family feel very lucky he got to be the first person to benefit from what amounted to an experimental intervention at the time.
sa国际传媒淚 mentioned to my mom, a week or two before May 20, 2017, I have two birthdays every year now,sa国际传媒� he said. sa国际传媒淚n my point of view, and everyone elsesa国际传媒檚 point of view, I actually did die on that day of my accident.sa国际传媒�
He said recognizing the second birthday is more of an observance than a celebration, however.
sa国际传媒淚sa国际传媒檓 not sure you can call it celebrating,sa国际传媒� he said. sa国际传媒淚t is a pretty big deal in my life, but it would be a bit weird to celebrate the day of the accident.sa国际传媒�
Donna said it is hard to explain how grateful they are.
sa国际传媒淎t first they told us he was not going to survive,sa国际传媒� she said. sa国际传媒淭hen it was, OK, if he does survive hesa国际传媒檒l have to live in an institution and be bedridden the rest of his life. We were always being prepared that we were going to have to make a choice whether we were going to continue treating him or not, but we just never gave up and the outcome has been incredibly wonderful.sa国际传媒�
Their gratitude is not just for the medical professionals, who saved his life and oversaw his recovery and rehabilitation, though.
sa国际传媒淭he family really thanks the community [of Smithers] for all the support,sa国际传媒� Donna said.
sa国际传媒淲e had a ton of support from family and friends and co-workers, so we would just like to say thank you to the community for all the support.sa国际传媒�
