22 Mar 2012

How did Fabrice Muamba ‘die’ for 80 minutes?

A doctor who attended to Fabrice Muamba after he suffered heart failure has said the footballer “in effect died” for more than an hour. But how can someone die and yet be able to speak 48 hours later?

Bolton Wanderers footballer Fabrice Muamba nearly lost his life when he suffered heart failure during the FA Cup game between Tottenham Hotspur and Bolton Wanderers on 24 March.

Speaking several days after the event, team doctor Dr Jonathan Tobin confirmed that “in effect, he was dead” for more than an hour on Saturday afternoon.

He continued: “Fabrice was in a type of cardiac arrest where the heart is showing lots of electrical activity but no muscular activity.”

Extraordinary progress

So how is it that someone can be described as “dead” for nearly 80 minutes and yet have responded to questions in hospital less than 48 hours later?

Dr Sam Mohiddin, one of the medial team at the London Chest Hospital where Muamba is recuperating, confirmed that it was extraordinary for Muamba to have made the progress he has since the weekend.

But it may be that those closely associated with the Congo-born footballer’s recovery were being – understandably – emotive in suggesting that he had “died” for a short period.

He wasn’t dead because he was being resuscitated. Without the facilities, that would have been the outcome. Dr Amanda Varnava

Dr Amanda Varnava, consultant cardiologist at St Mary’s, Imperial College, specialises in sudden cardiac death syndrome and the screening of athletes.

“He wasn’t dead because he was being resuscitated,” she told Channel 4 News. “Without the facilities, that would have been the outcome – that’s why it was described that way.”

In Dr Varnava’s view, the most likely scenario was that Fabrice Muamba experienced very rapid heartbeat rather than none at all.

“He would probably have been in VT (ventricular tachycardia – potentially life-threatening arrhythmia) or VF (ventricular fibrillation – uncoordinated contraction of the cardiac muscle of the heart), producing very fast electrical activity of the main pump chamber.

“It would have been so fast that it wouldn’t have been able to pump the blood sufficiently.”

Read more: Could tests have picked up Muamba heart problem?

Relying on CPR

Andrew Deaner, the Spurs supporter and consultant cardiologist who left the stands at White Hart Lane to assist Muamba, has said the first approach in his treatment was to slow down his metabolism by heavily sedating and anaesthetising him, then cooling his body temperature for 24 hours.

One hour and 20 minutes is unusual, and it’s unusual for someone to recover from it for so long. Dr Amanda Varnava

Mr Deaner has also suggested the footballer was saved by the quality of the medical team attending to him. Dr Varnava believes it ensured that Muamba’s CPR (cardiopulmonary resuscitation) chest compressions were applied properly, deeply and regularly – sufficient to replicate the function of the heart.

“If that was done sufficiently well,” says Dr Varnava, “then yes, you can circulate blood to the vital organs and could keep someone going for up to an hour before definitely sorting out their heart rhythm.

“So I think that’s why you have this scenario where he was effectively relying on CPR to keep him alive – that usually doesn’t go on for that long. One hour and 20 minutes is unusual, and it’s unusual for someone to recover from it for so long.”

And although it is early days to be discussing Muamba’s recovery, his textbook on-the-spot treatment has undoubtedly enhanced his prospects.

“If you were going to make a film to teach people how to run a complex arrest, this would have been the arrest to film because everything went as it should,” Andrew Deaner told ITN (see interviews above).