Jose Agredano Jr. got CPR from his mother after being struck in the chest by the ball during a soccer game — an impact that triggered a rare and often lethal medical condition.
March 9, 2017 - By Samantha Dorman
Jose Agredano Jr. was released last month from Lucile Packard Children’s Hospital Stanford following an unexpected and life-threatening incident. Doctors said he suffered what’s known as a commotio cordis — cardiac arrest caused by a blunt impact to the chest.
Agredano, 16, a sophomore at San Benito High School, was in the middle of an intense soccer game at Watsonville High School when he was hit by the ball in the chest. “It didn’t feel right,” he recalled.
“After the ball hit my chest, I passed the ball, took two steps and lost my balance. My vision went, and I started spinning,” he said. “I kneeled down and put my hands on the ground, and the next thing I remember, I was being put into an ambulance.”
His parents were at the game. His mother, Gina Agredano, MD, said she was chatting with another parent when she heard her husband, Jose Agredano Sr., say, “There’s something wrong with Jose.” Both parents ran onto the field toward their son, who was on the ground and unresponsive.
Gina, a physician, immediately began assessing her son. She hadn’t seen what had happened and assumed it was a head injury. She instructed her husband to hold his son’s head, and they directed bystanders to call 911. Jose was still breathing, but he was unresponsive during the roughly 10 minutes that his mother continued to assess him. She was looking for eye response and breathing patterns. When his breath became labored, she knew her son needed oxygen. She sent her husband to meet the paramedics and asked the sports trainer to get the automated external defibrillator, a portable device that checks a person’s heart rhythm and can send an electric shock to the heart to try to restore a normal rhythm. AEDs are used to treat sudden cardiac arrest.
“Right as first responders arrived and my husband left to get them over to us quickly, that’s when Jose stopped breathing and his lips began turning blue,” Gina said. “Up until that moment, I had this emotional connection to the situation as his mother. But at that moment, fight-or-flight kicked in, and I knew I had to begin CPR to save his life.”
She recalls giving chest compressions for about three minutes. The trainer returned with the AED just as the first responders arrived on the scene. Gina quickly told them the situation and said their eyes widened and that they jumped into action, cutting off Jose’s jersey and placing the AED pads on his chest.
The pad read an irregular heart rhythm, and the medics began to shock his heart.
“It was surreal,” Gina said. “I’ve seen a lot of things in my career, and I saw a lot of trauma in my residency, but when it’s your child, it’s a whole different thing. I just kept telling myself, ‘we’re not going to die today.’”
After the shocks, Jose came back. He was groggy, but he knew his name, what day it was and where he was. The whole ordeal lasted about 20 minutes, but it felt “like a year,” Gina said.
Jose was taken to the emergency room at Watsonville Community Hospital, where he was stabilized and examined by a Packard Children’s pediatrician, Peter Rowinsky, MD, who arranged for Jose to be transferred to the cardiovascular intensive care unit at Packard Children’s Hospital. Through a partnership between the two hospitals, Packard Children’s physicians can serve as hospitalists at the Watsonville hospital. Rowinsky is also a clinical assistant professor of neonatal and developmental medicine at the School of Medicine.
“Many victims of commotio cordis do not survive,” said Kathleen Ryan, MD, a cardiac intensivist who admitted Jose to the cardiovascular intensive care unit. Victims are predominantly men under the age of 20, which is when the chest wall finishes developing.
“Commotio cordis causes victims to go into ventricular fibrillation. CPR is not enough because the heart is quivering about 400 to 1,200 times a minute,” said Ryan, a clinical assistant professor of pediatric cardiology at the medical school. “You need to deliver an electrical shock that defibrillates the quivering heart and shocks it into a normal rhythm again, and statistically this shock needs to happen quickly, within a few minutes. In Jose’s case, the quick action his mother took by performing CPR and ordering the AED to be brought over made all the difference in the world.”
All of Jose’s follow-up tests were normal, and doctors do not anticipate there will be any long-term damage.
Lynda Knight, MSN, RN, director of the Stanford Children’s Health REVIVE Initiative for Resuscitation Excellence, said this is a reminder of the power of resuscitation education.
“Evidence shows that if a bystander performs immediate CPR, the outcome will be better. Paramedics take, on average, four to eight minutes to arrive, and each minute that someone goes without chest compressions, his or her chance of survival goes down by 10 percent.”
Every second matters, and knowing what to do can make the difference between life and death.
The REVIVE Initiative has trained thousands in the community in bystander CPR and provides its CPR training program to hospital parents upon discharge.
As for the Agredanos, the event was life-changing for all of them.
“I’ll never take anything for granted again,” said Jose Jr. “The last thing I saw before I lost consciousness was my parents’ faces. I know how lucky I am.”
“We’ve been at hundreds of games and have seen hundreds of hits to the head and chest. Never did we think this was possible,” said Jose Sr. “My wife was the hero. She was calm and efficient. I am so thankful she was there.”
For the sports community, Gina said it’s a reminder of how critical it is to immediately assess an injured player. “Every second matters, and knowing what to do can make the difference between life and death,” she said.
“If this happens to someone next to me on the field, now I know what to do,” said Jose Jr. “But I want all my friends to know, too.”
“My being a doctor, my training, that wasn’t what saved him,” Gina said. “Knowing the signs that call for administering CPR, which is accessible to anyone, is what saved his life.”
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