Returning to the Bay Area from a health-care conference on the East Coast, Stanford Hospital nurses Sophia Loo and Angela Bingham performed CPR on a passenger who appeared to be having a heart attack.
January 23, 2015 - By Sara Wykes
Sophia Loo and Angela Bingham barely made their connecting flight to San Jose. The cardiac care nurses at Stanford Hospital were on their way back from a December health-care conference in Orlando, Fla.
As they settled into their seats, Loo heard a woman a few rows ahead of her saying, “Sir, sir, are you OK?” and then, “I think this man needs help. Can someone help him?”
Loo saw a male passenger who appeared to be in real trouble. He was pale, unresponsive, sweating and breathing in a way that Loo recognized immediately. Called agonal respiration, it is accompanied by a snoring sound and comes in gasps. Loo knew the breathing pattern because it’s often a sign of imminent cardiac arrest. Bingham, seated a few rows back from Loo, had noticed the commotion and was on her way to help, too, when she heard Loo call out, “Angela, get up here!” Other passengers had left their seats, blocking the aisle and forcing Bingham to crawl over empty seats to get to the passenger.
Bingham and Loo had resuscitated many cardiac patients during their careers with Stanford Health Care, which is part of Stanford Medicine. “That’s expected as part of the job,” Loo said. “But in the hospital we have the proper equipment.”
Springing into action
Both nurses knew that they had to start CPR immediately. “But we couldn’t do CPR while he was in the seat,” Loo said, so she recruited three passengers to maneuver the man into the aisle. He was in his late 60s, Loo estimated, and weighed about 180 pounds. In the narrow aisle, there wasn’t much room.
“It was surreal,” Bingham said.
“We just went into nursing mode,” Loo said, “but the stress was beyond anything I’ve ever known as a nurse. We were so focused on what we were doing; we knew the gravity of his condition.
Lacking a ventilating device to help deliver air through the passenger’s nose and mouth — and because he occasionally gasped and opened his eyes, which would have interfered with rescue breaths — the nurses focused on chest compressions, conducted at a rate of 100 times per minute.
We just went into nursing mode, but the stress was beyond anything I’ve ever known as a nurse.
Flight attendants brought them an automated external defibrillator, which the Federal Aviation Administration requires all commercial aircraft to carry, giving Loo and Bingham their first chance for an objective reading of the passenger’s heart activity.
This type of defibrillator uses two adhesive-backed leads, which are placed on the skin of the chest, to evaluate heart rhythm and deliver an appropriate shock. The device showed that the man’s heart was in a life-threatening rhythm and advised a shock. “I told the flight attendant to press the button to deliver the shock. We called out ‘Everybody clear!’ and the shock did deliver,” Bingham said.
The nurses followed the shock by adminstering three minutes of CPR. When they did a second read of the defibrillator, it instructed, “No shock.” That advice, Bingham said, happens when there is no heart activity at all. But the two nurses continued to perform CPR. Once, the man opened his eyes, Bingham said, “so we knew something was happening, that we were getting through.”
Except for the sound of Loo and Bingham’s CPR count, the other passengers on the plane were silent. “People were in shock, I think,” Loo said.
“We lost track of time,” she said, “but it was at least 15 minutes until a security person came to help us with CPR.” Paramedics finally arrived to help, too. By the time the passenger was carried out of the plane — the aisle was too narrow for a gurney — he was conscious again, Loo said.
This reinforced why I went into nursing.
Loo and Bingham were rewarded with a round of applause from people on the aircraft, and someone called out, “Great job, girls!”
It was another 45 minutes before the plane finally left the airport. During the wait, Bingham said, “People were asking me about what we had done, about the CPR technique we’d used — and the captain came to thank us.” The flight attendants came to ask for the nurses’ advice on what the crew could have done differently. Since then, Loo and Bingham haven’t heard any news about the passenger. “We would like to know how he is now. We hope he’s doing OK,” Loo said.
“This reinforced why I went into nursing. I was so humbled and grateful that I could do something, that Angela and I knew what to do,” Loo said.
Stanford Medicine integrates research, medical education and health care at its three institutions - Stanford University School of Medicine, Stanford Health Care (formerly Stanford Hospital & Clinics), and Lucile Packard Children's Hospital Stanford. For more information, please visit the Office of Communication & Public Affairs site at http://mednews.stanford.edu.