An 11-year-old Austin soccer player's heart stopped for 22 minutes. Doctors explain why

Sabine Barrett has returned to the soccer field. Not yet as a center midfielder for her Lonestar Soccer Club select team in Austin, Texas, but she is back as an assistant coach while she waits for her heart to heal.

Sabine, an 11-year-old sixth grader, suffered a cardiac arrest on the field after a practice on Jan. 19.

A team of people on the field kept her alive long enough by doing CPR to get her to Dell Children's Medical Center of Central Texas, where doctors could diagnose her with a coronary artery anomaly and do immediate surgery to repair her heart.

This wasn't Sabine

Sabine has been playing soccer since she was 4 years old, which typically means twice-a-week practices and games on the weekends during the season.

On this practice, though, she said, everything around her became really bright, even though it was 9:30 at night. Her chest hurt. "It was hard to breathe. I was dizzy."

This had happened two other times, in March 2022 and November 2022, but she had recovered.

On this night, though, she seemed really tired at the end of practice. After taking a break, she seemed fine, and Sabine and her father, Dan Barrett, starting kicking around balls again. Her father sent a ball out to the middle of the field, but she didn't run after it. She told him, "It's happening again. My chest hurts. I hate this. I'm dizzy."

Then she fell to the ground.

"This isn't just a fainting or a fall," Dan Barrett said. He could tell by looking at her that it was "100 percent an emergency."

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Her coach, Nic Snyder ran out to the field to meet Dan and Sabine. Dan Barrett called 9-1-1.

"We didn't think heart at the time," Dan Barrett said. In fact, he said, if it hadn't been his child, if he didn't know how she looks and acts regularly, he might have been more cautious. He might have been a bystander who did nothing, he said.

"Sabine is a strong, dynamic kid," her father said. Legend has it that she was undefeated in arm wrestling at school. This wasn't her on that soccer field that night.

The 9-1-1 communications medic, who they knew as Paula, was amazing, Barrett said. She was calm and gave them clear instructions to try to find a heart beat, then to count breaths. They could not find a heart beat or breaths.

She told them, "You need to start chest compressions," Barrett remembers.

"It was a tragic fear of a father to hear that on a soccer field,' Barrett said. "It was a call to action for Coach Nic."

Snyder immediately found Sabine's sternum and locked his hands and started chest compressions.

"Thank you so much to 9-1-1 dispatch for your help because you were everything for me that night.," Snyder said at a press conference after Sabine got out of the hospital. "... I'm happy that I was prepared to do what needed to be done."

Help arrives

The 9-1-1 communications medic stayed with them until a fire department team started running up the field.

"These types of calls take a community," said Mike Wright, chief of operations at Austin-Travis County (Texas) EMS.

Austin Fire Department Station 51 took over CPR and started using an automated external defibrillator to deliver a shock to try to get Sabine's heart into a normal rhythm.

Then Austin-Travis County EMS team Medic 40 brought advance life support to the field. "We take the emergency room and the ICU out of the hospital and put it on the soccer field," Wright said.

They started ventilation and intravenous lines and began delivering medications to stabilize her heart. Commander Craig Smith from EMS also arrived to oversee the operation and start thinking about what needs to happen in the next minutes and down the line. "This all has to work seamlessly together," Wright said. "There can be no gaps in this. On this evening, it worked perfectly."

At 22 minutes after Sabine dropped to the ground, her heart started again, Wright said. "What's amazing to us, if we did not have bystander CPR, if we did not have the Austin Fire Department, the Austin-Travis County EMS paramedics, and Commander Smith all of this together, that 22 minutes would have a completely different outcome."

The team kept Sabine's airway and heart stable while STAR Flight landed to take Sabine and her father to Dell Children's. By this time, Sabine's mother Ginny Barrett and her older brother Roman had arrived and an Austin Police officer arranged to take Roman home and check on Sabine's other two siblings. Another officer took Ginny to the hospital to be with her daughter.

A specialized heart team at work

Four minutes later, Sabine arrived at Dell Children's. In the emergency room, pediatric cardiologist Dr. Karen Wright met with Sabine's parents, and explained what she thought was happening to Sabine after interviewing them about what they saw on the field.

When the heart is developing in the womb, there's "a very tiny glitch," Wright explains that happens when the coronary arteries don't come out of the aorta correctly.

In Sabine's case, the left coronary artery instead of coming from the left side, came from the right side and into the wall of the aorta for a long segment and then to the left side of the aorta.

When Sabine was exercising, in increased the pressure in that artery, which got collapsed against the wall of the aorta, restricting the blood flow. That then caused the abnormal arrhythmia and cardiac arrest.

Five years ago, one of the best doctors for repairing coronary arteries, Dr. Carlos Mery, came to Austin to start the Coronary Anomalies Program at the new Texas Center for Pediatric and Congenital Heart Disease, a joint program of Dell Children's, Dell Medical School and UT Health Austin, the clinical practice of the medical school.

"Things are happening quickly in Austin," said Dr. Charles Fraser Jr., the head of the Texas Center for Pediatric and Congenital Heart Disease. "So much is changing. It's wonderful that we have been able to attract people like Dr. Mery to Austin, truly a world expert."

Mery is leading the research into when to fix these anomalies, but in Sabine's case, there was no question. She needed immediate medical intervention.

Mery said, while this is rare, about 1 in 100,000 people have an anomaly like this one, but "there's a lot of uncertainty that surrounds this."

He is leading the registry to study people with coronary artery anomalies to help better understand when surgical intervention is worth the risks and when it's better to just watch it. He's also leading a study about what questions caregivers have about coronary artery anomalies and how providers can better answer them. And he's looking to the future to team up with UT's biomedical engineering department to work on better simulations for these surgeries.

In the case of a cardiac arrest, it's always a case of doing surgery. Once Sabine arrived at Dell Children's and throughout that night, she was very stable, but Mery knew that the evidence points that if surgery isn't done to correct the anomaly immediately, another cardiac event is more likely to happen within the next few days, Mery said.

With these anomalies, critical events like what Sabine experience typically happen between ages 10 and 35, Mery said. This is another mystery, but it could be that this is when people are the most active; it could also be that as a person ages, the arteries get more rigid and are not at risk for compressing, Mery said.

While this is the second leading cause of cardiac death in young athletes, Mery said, "It's not like we see every day someone collapsing on the soccer field." It does happen. In February Belgium soccer goalkeeper Arne Espeel died of a cardiac arrest on the field at age 25.

"It's very dramatic and very traumatic," Mery said, when it does happen because these athletes often give the picture of good health.

Once all the tests including a CT scan were done on Sabine that confirmed the anomaly, Wright met with her parents and told them, "If my kid had this condition anywhere in the country, I would drive to this center for Dr. Mary."

Wright drew images on a white board to explain the anomaly to her parents.

"The way that Dell handled their communications was so transparent," Dan Barrett said. "They were bringing us along like we were part of the team."

Once they had the information, "it felt reassuring," Ginny Barrett said. "This is exactly what it is and this is exactly what we need to do. ... it was a weird peace."

Fixing Sabine

There are two different ways to fix an anomaly like Sabine, Mery said. The first is an unroofing. They take a piece of the aorta and move it to the side, which allows the coronary artery to be on the correct side. This procedure works if the the segment of the artery is above the aorta.

If it's below, then an unroofing won't work. In that case, they have to divide the artery and move it the correct side of the aorta rather than letting it run through the aorta. In Sabine's case her left coronary artery had a significant amount that ran into the aorta and was below the aorta.

These surgeries are not that common. Mery said he has done about 60 to 70 in his career, and sees about five to 10 patients a month with this anomaly. He's getting asked for second opinions from as far away as Australia, because he's known at the expert with some of the most experience.

The surgery took most of the day Friday, Jan. 20. Once Sabine was out of surgery, she was kept sedated for a while. There were still concerns about if there had been any neurological damage done from the cardiac arrest. When she woke up on Sunday morning, she thought there had been a zombie apocalypse and that the TV was a portal to a unicorn world.

She doesn't remember much of anything, but one of the first things she told her parents was, "Gee that was weird."

By Wednesday, six days after her cardiac arrest, Sabine was heading home.

The future for Sabine

For now, Sabine is back at school full-time, but having to skip gym class and is coaching for her soccer team rather than playing. At the end of April, she'll have a stress test to see if she can return to playing.

Sabine once scored four goals in one game. Now with a health heart, "it's going to be a lot of fun to watch," Dan Barrett said. Maybe she'll score five or six in a game.

Sabine will be followed up regularly throughout her life.

She has shown no neurological effects.

This type of surgery has only been done for about 20 years, so doctors cannot say for sure that she is fixed for good, but Wright said, "we believe this is the only surgery she'll probably need for this problem."

"Her life was saved because somebody knew how to do CPR," Wright said. "Good CPR is life-saving and brain-saving."

Wright also advocates for having an AED, a automated external defibrillator, available at public spaces. In Sabine's case, EMS arrived quickly with an AED, but spaces like soccer fields, school gyms, public spaces, anywhere where people congregate, are idea for AEDs, Wright said. They cost about $1,500. Even if that AED isn't used on an 11 year old, because it's rare for a child that age to need it, "that 11-year-old has a grandparent. It might save the grandparent's life or the coach's life," Wright said.

For the coach, who did CPR and saved Sabine's life: "I hope that the next child out there has someone who can come run up and help them," Snyder said.