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HEALTH

The miracle of Audrey – The English teacher brought back from the dead in Spain

Just over a month ago, Audrey Mash was, for all intents and purposes, dead. And for six hours she had no heartbeat.

The miracle of Audrey - The English teacher brought back from the dead in Spain
Audrey Mash alongside one of members of her rescue team. Photo: Vall d'Hebron

But on Thursday her case was presented at a hospital in Barcelona as a survival story that could change the way hypothermia is treated.

The 34-year-old Briton had been on a trip to Vall de Núria in the Catalan Pyrenees with her husband Rohan Schoeman to celebrate their sixth anniversary and the pair had set off early from a mountain hut for a day hiking in the snow.

But the couple, who mived to Barcelona in 2017, were caught in a snowstorm and as temperatures plummeted they lost their way and sheltered from the wind and the cold crouching in the lee side of a rock.

For several hours the pair clung to each other for warmth waiting for the weather to clear, but Audrey’s body temperature dropped and she started behaving strangely.

“She started talking nonsense,” her husband recounted to La Vanguardia newspaper. “Then she stopped talking altogether and just made grunts, and then she stopped moving and slipped into unconsciousness.

“Her eyes sort of rolled back and she breathed what seemed to be her last breath,” he said. “I look for a pulse but I found nothing, no sign of life.”

Rohan had already raised the alarm, sending friends’ pictures of their location, and at 3.40pm on the afternoon of November 3rd, a rescue team finally reached them.

But by now, Audrey was turning blue and her body temperature had dropped to 18C and she had entered cardio-respiratory arrest.

Many may have given up hope and given her up for dead but thanks to quick thinking by the rescuers who believed that there might still be a possibility of survival, if they could only get her to the hospital and to the right team, she was airlifted to hospital and arrived at the Vall d’Hebron in Barcelona shortly before 6pm.

Eduard Argudo, an intensive care doctor specializing in hypothermia had just finished a 24 hours shift at the hospital that morning but immediately rushed to meet the helicopter as it arrived.

“I saw a young woman in cardiac arrest and no sign of life. She was pale and blue, with a body temperature of 20.2C. The only good thing is that she was so cold because everything else looked very bad indeed,” the doctor told a press conference at the hospital on Thursday.

She had no vital signs, her heart was showing no electrical activity and her kidneys and lungs were not functioning. In most cases, the story would have ended there.

But not at the Valle d’ Hebron. The patient was immediately placed on an extracorporeal membrane oxygenation (ECMO) machine which oxygenates the blood and gradually warms it to increase body temperature while the heart remains stopped.

“We didn't know if it would work but it was the only option,” says Argudo. “Although we knew there was a risk of neurological damage”.

When she warmed to 30C the doctors tried to defibrillate and get the heart beating on its own. It finally started to beat autonomously at 9.46pm.

On Thursday a smiling Audrey Mash sat beside her husband surrounded by the dozens of people who were involved in her rescue.

 

(In the picture above you can see Audrey on the far left next to her husband and the bearded Dr Eduard Argudo).

Her doctor said part of the reason she survived was due to the hypothermia.

“The hypothermia killed her but also saved her at the same time. With the cold, the body's metabolism slows down, the organs need less blood and less oxygen and that helps protect the brain,” he explained.

“She was able to recover because the brain cooled rapidly and its need for oxygen was reduced before cardiac arrest,” he explained, adding that it helped that she was a fit young woman who regularly runs marathons. 

“When cardiac arrest first occurs and then cooling, as usually occurs in avalanche victims, the prognosis is very bad. But when it is hypothermia that causes cardiac arrest, as in the case of Audrey, we must try to save the victims because survival without serious consequences is possible. ”

Audrey said she has made a full recovery, apart from a numbness in her fingers.

“I didn’t realize that my life was in danger until I woke up in hospital,” Audrey told the press on Thursday.  

“The medical attention has been fantastic.”

“I feel so incredibly grateful to be alive, to all the doctors, medics, rescue teams who went above and beyond their duty to save me. I'm incredibly lucky,” she said. 

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HEALTH

How Spain could stamp out smoking

A fifth of Spain's population smokes on a daily basis. With such high numbers, here's how the country's pulmonologists propose to get smokers to quit.

Spain plans to get people to quit smoking
How Spain plans to get people to stop smoking. Photo: Khalil MAZRAAWI / AFP

For many outsiders, Spain is a nation of smokers. 

The stats from Spain’s Ministry of Health show that 23.3 percent of men smoke every day in Spain, compared with 16.4 percent of women.

For both males and females, the highest number of smokers are aged between 25 and 34, meaning that it’s the younger population who are smoking slightly more than the older generations. 

Spain’s pulmonologists are now pushing for the country’s tobacco laws to be tightened, claiming that reform is needed after the last legislation was approved a decade ago.

READ ALSO: Spain warns against smoking and vaping in public to avoid Covid infections

Why is smoking such a problem in Spain and what is being done about it?

The latest stats from the Spanish Ministry of Health show that lung cancer, often caused by smoking, is the third most frequently diagnosed cancer in Spain, with 29,549 cases diagnosed so far in 2021.

Given these high figures Spain’s Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) has proposed five measures to help get people to stop smoking.

SEPAR points out that every time anti-smoking legislation is reformed and things for smokers made more difficult, the prevalence of smoking decreases.  

Smoking on terraces was banned in some regions during the pandemic. Photo: CRISTINA QUICLER / AFP
  • Price of tobacco to rise in 2022

The first point on their list is to raise the price of tobacco, which must cover all forms, from cigarettes to cigars, through to rolling tobacco, and electronic cigarettes.  

This first measure may soon become a reality as the Spanish government has already predicted that the price of tobacco will rise in 2022, after several years of stagnation.  

It is expected that tobacco will be responsible for almost a third of all special taxes received in 2022, equating to €21.8 billion.

According to the World Health Organization (WHO), “cheap tobacco” in Spain guarantees “a percentage of smokers above 30 percent”.

In Spain, the price of a pack of tobacco is around €5, which is much cheaper than in other countries. In Australia for example, a pack of tobacco costs around €22, and in the United Kingdom and France, each pack of tobacco costs around €12.4 and €10.5, respectively.

According to Dr. Carlos A. Jiménez Ruiz, pulmonologist and president of the society, the current anti-smoking law has “some deficiencies” that need to be addressed in order to develop legislation that is more effective and efficient, especially with regard to the prevention of tobacco consumption in young people, but also in helping smokers to stop smoking and in protecting the health of non-smokers. 

READ ALSO – Maps: Which beaches in Spain have banned smoking?

Besides increasing the cost of tobacco SEPAR proposes four other measures to get Spain to quit smoking. These include:

  • Banning the consumption of tobacco in public spaces, even outdoors
    During the pandemic, several regions approved a regulation to prohibit smoking on terraces. SEPAR proposes that smoking be prohibited not only in spaces such as terraces but also in sports stadiums, beaches, parks and bullrings, and that fines should be imposed for those who do not comply.

  • Establish generic packaging
    SEPAR also wants Spain to introduce generic packaging, which means no logos and images of the tobacco companies. This measure has also proven to lower the sales of tobacco in countries where it has been implemented, such as Australia and New Zealand. According to the latest statistics from the Australian National Drug Strategy Household Survey around 11.6 percent of adults in Australia smoke daily. 

  • The regulation of other smoking devices
    Despite the fact that all products that burn tobacco such as cigarettes are already regulated, SEPAR believes that it is also necessary to regulate the sale, consumption and advertising of electronic cigarettes. This is because e-cigarettes have become particularly popular among young people. 

  • Promote help for those seeking to quit smoking
    The last proposal is the creation and development of special units in public health departments to help people to stop smoking and to put more funds towards these programmes. 

How does Spain compare with other European countries when it comes to smoking?

According to the Organisation for Economic Cooperation and Development (OECD), while Spain does have a high number of smokers there are still several European countries that have more. The European countries with the highest number of smokers are Greece, Bulgaria and Hungary.

The latest European survey from 2020 shows that 42 percent of Greeks claim to be smokers, which is only slightly above Spain. 

On the other side, the European countries with the lowest number of smokers are mainly Nordic countries, such as Sweden, Finland, Iceland and Norway.

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