Damar Hamlin’s neurological recovery reaches ‘tipping point’

Damar Hamlin’s ability to communicate with medical staff and members of his family following Monday night’s cardiac arrest bodes well for his brain’s recovery, according to the doctors treating him and outside medical experts.

“This marks a really good turning point in his ongoing treatment,” said Dr. William Knight IV, director of emergency medicine at the University of Cincinnati Medical Center, who has been treating Mr. Hamlin since he collapsed on the field during a Buffalo Bills-Cincinnati Bengals game. “But he still has significant progress to make.”

While experts have reason to believe Mr Hamlin may be well on his way to neurological recovery, questions remain about the health of his other organs, including his lungs.

In a press conference on Thursday, Dr. Knight and Dr. Timothy A. Pritts that Mr. Hamlin was still critically ill, was in the intensive care unit and was still lightly sedated and ventilated and therefore unable to speak. But he can now communicate by shaking his head and nodding. He even wrote a question on a pad asking his nurse who won the game.

dr Knight and Dr. Pritts said during the press conference that they were not yet sure why Mr. Hamlin went into cardiac arrest during the game. But one explanation they haven’t ruled out is that he was incredibly unlucky when he collided with a Bengals receiver and suffered a severe blow to his chest. If this happens at just the right moment, 20 milliseconds into the heart cycle, when the organ is relaxing and filling with blood, the beat can stop the heart.

More on Damar Hamlin’s breakdown

The consequences can be dire even if, as in Mr. Hamlin’s case, the person is immediately given cardiopulmonary resuscitation and their heart restarted with a defibrillator.

“The big problem with cardiac arrest is the lack of blood flow to the brain,” said Dr. Andrew Luks, a critical care and respiratory specialist at the University of Washington who is not involved in Mr Hamlin’s treatment.

While it’s impossible to do a full neurological exam while Mr. Hamlin is on a ventilator, “the fact that he’s following directions and communicating in writing is very reassuring,” said Dr. luks. “The likelihood of serious neurological damage is very low.”

“There is every reason to believe that he will return to normal neurological function,” said Dr. Michael Mack, chairman of cardiovascular services at Baylor Scott & White Health in Dallas.

But recovery is not immediate, he added. Patients go through a phase where they are slow to respond and responsive in conversation.

Another major problem with cardiac arrest is damage to the lungs, a serious injury called acute respiratory distress syndrome, or ARDS. One study found that nearly half of people who had cardiac arrest developed the disease.

Sometimes CPR injures the lungs during repeated, deep compressions of the chest wall. Patients can also inhale gastric fluid or saliva into their lungs and injure them. And the impaired blood flow during CPR can contribute to lung damage.

Mr. Hamlin did not escape this complication.

There is no specific treatment for ARDS, said Dr. Douglas White, a professor of critical care medicine at the University of Pittsburgh Medical Center, other than making sure the ventilator is set to deliver smaller-than-normal breaths to avoid additional lung damage. Doctors then monitor patients and wait for them to heal, which can take days or weeks.

While most patients make a full recovery, some have scar tissue left in their lungs, said Dr. White. For many, the scar tissue isn’t serious — but, he said, “for a world-class athlete” performing at peak physical levels, “it’s a different issue.”

Scarring becomes a problem when someone is on a ventilator for a week or more, Dr. White added. So far, Mr. Hamlin has been on a ventilator for three days.

“The next big milestone,” said Dr. Pitts, “will make him breathe on his own.”

Mr Hamlin’s doctors declined to predict when or if he would make a full recovery and if he would be able to play football again. They said they were just taking things day by day.

“It’s been a long and difficult journey over the past three days,” said Dr. Knight. Mr Hamlin, he said, was “incredibly ill”.

But, he said, “he is now showing signs of a good neurological recovery.”