When David Mills of Vista, California, went into cardiac arrest on April 8, it took 70 minutes of CPR to restore his regular heartbeat.
Now, telling his story after 11 weeks of recovery, the retired carpenter says he does not remember much about the time he spent unconscious, his heart locked in a seizure-like pattern called ventricular fibrillation that stopped the vital organ from pumping blood.
The likelihood of his successful return to a full life — albeit with some lingering memory problems — was less than 1 percent.
Living, after coming so close to death, is a delight, he said.
"Each day it gets better," Mills said. "I'm just happy to be here and be with this girl and just take every day for how special it is.
"You appreciate a lot of things that felt normal before."
The chain of events that brought him to this moment started just before 1:30 a.m. that Saturday in April when Georgia Mills noticed that her husband, lying beside her in bed, made a strange rattling noise.
"It wasn't enough time for him to wake up and say anything to me," she said. "His arms were by his sides. I lifted up an arm and it fell right back down. I shook him and there was no movement."
She called 911 and her 25-year-old grandson, Jacob, who lives with the couple, began cardiopulmonary resuscitation with over-the-phone guidance from an emergency dispatcher.
Chest compressions and a few attempts by Georgia at mouth-to-mouth kept Mills' blood moving for the five minutes that passed before emergency medical personnel arrived.
Flooding into the couple's second-story bedroom, the professionals took over, quickly detecting that his heart was in ventricular fibrillation.
An attempt to shock Mills' heart back into a regular rhythm using an automatic defibrillator failed, so an automatic CPR machine capable of delivering compressions at precisely the correct intervals was attached to his chest, continuing to do its work even as paramedics carried his gurney downstairs for a ride to Tri-City Medical Center in Oceanside.
By the time the ambulance arrived, Dr. Andrew Fischer, an emergency medicine specialist at Tri-City, said that CPR had been under way for 35 to 40 minutes. That's already a very long time to survive without a heartbeat.
"Usually, when cases pass 20 minutes, the survival rate goes down a lot," Fischer said. "Most of the diagrams they have for measuring mortality (probability), they don't usually go past 50 minutes or so, because at that point, the mortality is very, very close to 100 percent."
Mills' biggest advantage, the physician said, was that family members and paramedics were so quick to come to his aid, starting chest compressions within a few minutes of his heart attack. Outside six minutes without oxygen, brain cells begin to die, making full recovery impossible.
Dr. Andrew Ho, a Temecula cardiologist and board member of the American Heart Association's San Diego and Southwest Riverside County chapter, agreed.
That quick intervention made everything else possible. It's a message that everyone everywhere should heed.
"Cases like this, they show the need for more public education, more widespread knowledge of CPR, because that's what really makes this kind of miraculous case possible," Ho said.
If the initial response is quick enough, it clears a little elbow room for modern medicine to get involved, and that was certainly the case for Mills.
Emergency room personnel slipped a breathing tube into his lungs, ensuring that oxygen-rich air was penetrating deeply enough to make it into his bloodstream and special medication capable of helping the body break away from that paralyzing arrhythmia was administered.
All the while, the CPR machine kept on pressing, eventually leaving Mills with four broken ribs.
Gradually, Fischer said, he began to notice signs that Mills' condition might be improving.
A heart monitor showed that the organ was still locked in ventricular fibrilation. While that's not a positive place to be, it actually showed that the cardiac muscle still had strength. Lack of oxygen eventually weakens the heart so much that it falls into a more-relaxed state called "pulseless electric activity," and that had not happened yet.
It seemed that fresh oxygen was still entering through the lungs and reaching vital organs. A pulse oximeter, capable of showing the oxygen concentration in a patient's blood, backed up what the doctor's eyes were observing.
"When he first came in, I remember his face and hands were a little bit blue, but once we had the breathing tube down, his face became pink, so you can sort of tell that what we were doing was working," Fischer said.
At the 70-minute mark, another dose of medication and another defibrillator shock brought Mills' pulse back into a blood-pumping pattern.
He was eventually cleared to receive a heart stent to reopen the blocked blood vessel that caused his heart attack and he was immediately placed in a temperature-control protocol — hypothermia treatment — to drop his blood temperature a few degrees below normal.
Dropping blood temperature helps prevent swelling, which can be a major issue for brain recovery among those who receive CPR for so long. The chances of a potentially harmful fever are also reduced, but patients must be heavily sedated to keep them comfortable.
Mills was kept heavily sedated into Easter Sunday morning to prevent discomfort while the cooling protocol proceeded, finally opening his eyes at about 4 p.m.
Today, though his short-term memory still has its problems, the husband and grandfather says he feels healthy despite a continuing struggle with rheumatoid arthritis that was present before the heart attack.
Where did he go during his 70-minutes without a heartbeat?
"I don't remember anything when I was unconscious," he said, adding that he has started to remember "little bits and pieces" of the ambulance ride to the hospital.
Other than a little unexplained anxiety Friday, Mills said there were no memorable signs of the heart attack. Due to his rheumatoid arthritis, the couple had been working to minimize salt and red meat in their diets for some time, and both walk regularly for exercise. But it appears genetics played a role. Most of the men in Mills' family suffered similar heart-related maladies.
Georgia, who had been told at the outset that the chances of her husband escaping severe brain damage after so long undergoing CPR were extremely low — inside of 1 percent — said she knew the moment he made it back intact.
"I walked in and he leaned over and said, 'can I have a kiss?'" she said. "I said 'hell, yeah, hell, yeah, you can.'"
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