Audrey was resuscitated at Vall d’Hebron after more than six hours of cardiac arrest due to severe hypothermia, thanks to ECMO

When Audrey Mash, a 34-year-old British woman, arrived at Vall d’Hebron Hospital, her body temperature was 20 degrees Celsius. Her heart had already stopped beating three hours earlier.

On 3 November 2019, Audrey and her husband Rohan set out on a hike from Coma de Vaca to Núria. The weather conditions worsened throughout the morning due to the cold and snow. They sheltered behind a rock, hoping that the storm would ease. Audrey does not remember anything about that day, but Rohan explains that after a few hours, he noticed his wife was speaking strangely and incoherently, and shortly afterwards, she stopped moving and lost consciousness.

Some friends of the couple had alerted the Generalitat Fire Brigade, and the rescue operation was already under way. It was difficult to locate and reach them in such adverse weather conditions, but Audrey was eventually transferred to the helicopter.

At Campdevànol, the firefighters began cardiopulmonary resuscitation manoeuvres until an SEM helicopter transferred Audrey to Vall d’Hebron Hospital. Audrey was finally admitted to the hospital at 5.44 pm. Dr Eduard Argudo from the Intensive Care Medicine Department and a member of the ECMO Team coordinated by Dr Jordi Riera were waiting for her. Everything was already in place to perform ECMO (extracorporeal membrane oxygenation). The aim of performing ECMO was to oxygenate the blood and perfuse her tissues, as well as to rewarm her and gradually raise her body temperature. Her heart showed no electrical activity, there were no vital signs, her skin was cold and she had signs of lividity. She appeared to be dead, but in the context of hypothermia, it was thought that Audrey still had a chance of survival.

Audrey remained in cardiac arrest in the ICU while her body continued to be rewarmed. By 9.46 pm, her body temperature had reached 30 degrees Celsius. It was decided to deliver an electric shock to try to restart her heart. And that is what happened: her heart began to beat again spontaneously. More than six hours had passed between the moment her heart stopped and the moment it started beating on its own again. Once she had been stabilised, Audrey developed multi-organ dysfunction, which required treatment in the ICU, where she stayed for six days. “We wanted to monitor her continuously to assess her physical and neurological recovery. We were particularly concerned about possible neurological after-effects, as there are virtually no known cases of people whose hearts have been stopped for so long and who have been successfully resuscitated,” explains Dr Eduard Argudo.

Eleven days later, Audrey left the hospital on her own two feet. One month after the accident, she had already resumed her normal daily activities. Fortunately, she was left with no neurological after-effects. Nor does she have any memory of that Sunday, 3 November. But she does have a deep sense of gratitude towards the great team of professionals who, through their efforts, saved her life.