The Feb. 4, 2018 episode of NBC TV drama ‘This Is Us’ broke the hearts of viewers around the U.S. Fans watched in despair as the show’s beloved patriarch, Jack Pearson, had a catastrophic heart attack and died alone in a hospital room. Jack had suffered severe smoke inhalation after saving his family, their dog and a few sentimental items from a tragic house fire. His wife would later call it a “widowmaker’s” heart attack, which refers to a blockage of the left anterior descending artery, or widowmaker artery—the largest artery that brings blood to the heart.
Viewers took to social media immediately, lamenting Jack’s death and questioning whether he could have been saved. Patients and colleagues have been asking me the same thing. Unfortunately, the answer is yes—in a modern emergency department, the TV doctors could have saved Jack’s life.
Below are a few factors that today’s doctors understand and that could have changed Jack’s outcome:
- The doctors should have immediately assessed his airway and provided continuous oxygen through intubation or a facemask.
- A patient should never be left alone in their room after suffering smoke inhalation.
- Surface symptoms should not be the main concern when no burns are present. The doctor also should consider poor oxygenation of the heart.
The third point is the real kicker to me as a Burn Center doctor. What took Jack’s life—and what takes the lives of thousands of people in the U.S. each year—was not simply a heart attack. He died because the smoke he inhaled disrupted the delicate balance of oxygen and carbon dioxide in his cardiovascular system. And one thing is clear after the outpouring of shock at his death: We need to better educate our community about the dangers of heart damage from smoke inhalation, as well as measures to prevent it.
How can smoke inhalation cause a heart attack?
The heart is dependent on oxygen. When the flow of oxygen through the bloodstream is compromised, the heart rate slows down and eventually stops. This is called hypoxic arrest, or bradycardic arrest.
Today’s emergency medicine and Burn Center doctors know that smoke inhalation can disrupt oxygen flow due to:
Airway restriction
Smoke and particles in the air after a fire can irritate the throat tissue, causing it to swell and constrict air flow. This is the first symptom emergency department providers should check with suspected smoke inhalation. Poor breathing leads to poor oxygenation, and lack of oxygen can lead to a heart attack.
Carbon monoxide
Carbon monoxide binds to hemoglobin, which is the oxygen delivery molecule of the red blood cells. This prevents the red blood cells from properly delivering oxygen to the heart, which can cause cardiac arrest.
Underlying heart conditions
Cardiac problems such as congestive heart failure or arrhythmia can be exacerbated by the stress of a experiencing a house fire.
Chemicals from the fire
A patient can be poisoned by chemical toxins in the blood before they make it to the emergency department. Patients who do make it to the hospital must be closely monitored because chemicals can take a few days to leech into the airways.
With so many potential causes of cardiac arrest, emergency medical providers must follow a critical protocol to prevent more heart attacks and save more lives.
Emergency steps prevent smoke-related heart attacks
First, the patient must be taken to the nearest emergency department as soon as possible. Once the patient arrives, the emergency care team should immediately assess the patient’s airways. If they can see swelling or constriction—or if it’s even suspected—the patient should be intubated right away and given continuous oxygen. Even if there is no swelling and the patient is breathing fairly well, oxygen should still be given through a face mask.
Next is the most important step. We must diagnose the severity of disproportion to the patient’s blood oxygen and carbon monoxide levels. Without proper oxygen flow, the patient’s heart will stop pumping and they could suffer a heart attack. We always make the diagnosis by taking blood samples to precisely measure a patient’s blood gases: oxygen, carbon dioxide, carbon monoxide and other chemicals. As soon as the lab team delivers this data, we can adjust the patient’s oxygen levels and start measures to normalize their blood gases and prevent cardiac arrest.
It might seem strange that a Burn Center doctor is discussing blood gases and airway constriction. But our Burn Center team cares for burn and smoke inhalation patients all day, every day, and we have extensive expertise in managing both conditions together and separately. Emergency medicine doctors at hospitals across the D.C. area know that they can call the doctors at our Burn Center to consult on the care of patients who suffer smoke inhalation, and they do so frequently. Once the patient is stabilized, we work with them to transfer patients who need specialized care to our Burn Center.
How to reduce your risk of smoke inhalation and heart attack
Several actions Jack should have taken might have reduced the amount of smoke he inhaled on “This Is Us.” The storyline teased Jack’s fate in a previous episode in which the Pearson family’s smoke alarms registered low batteries, but no one changed them. That simple act could have tipped off the family earlier that their house was on fire, and Jack theoretically could have escaped with less toxicity in his bloodstream.
As many angry Twitter respondents pointed out, Jack should not have returned to the burning house once the family was safe outside. He went back to rescue the family dog and save a sack of sentimental family items. While I empathize with the emotional agony of leaving beloved pets or possessions behind, it’s vital that people in our community understand that flames are not the only killer in a fire. Smoke inhalation can be—and often is—fatal.
If you’re ever in a house fire, avoid contact with smoke any longer than is absolutely necessary. Call 9-1-1 immediately to get emergency care for anyone with burns or suspected smoke inhalation. And stay outside once your family is safe. Things can be replaced. Your lives can’t.
