A teenage girl who had a heart attack at an overnight camp was brought back to life by a school pal.
The previously healthy 14-year-old went into cardiac arrest - and became unresponsive in her cabin.
Her heart stopped for 10 minutes. A quick-thinking fellow camper began chest compressions after not finding a pulse.
It bought the dying girl vital time as a doctor, nurses and paramedics raced to the scene.
The young patient had myocarditis which causes inflammation of the heart - a common cause of sudden deaths in children. It peaks in early infancy and middle teenage years.
It was only thanks to the immediate actions of her observant friend and the quick response of ambulance staff she survived - and made a full recovery.
The case, reported in the Canadian Medical Association Journal (CMAJ), provides a "roadmap of how to plan for a rare but often fatal event," said doctors.
Her roommate had taken lessons on first aid - and remembered exactly what to do in such an emergency. She started performing CPR.
Dr. Herbert Brill of McMaster University said: "A fellow camper did not feel a pulse and immediately initiated chest compressions while others called for help."
Cardiopulmonary resuscitation is a first aid technique that can be used if someone is not breathing properly or if their heart has stopped.
You place the heel of your hand on the breastbone at the center of the person's and the other hand on top - interlock your fingers.
Using your body weight and arms, you then press straight down by 5–6cm on their chest - and repeat until help arrives.
Brill said: "Each additional minute of delay to shock is associated with an 8% decrease in one-month survival.
"For our patient, a number of elements in her care contributed to her successful resuscitation and intact neurologic survival.
"She had a witnessed arrest by a fellow camper trained in basic life support, who immediately started CPR with good-quality compressions.
"The bystander was quickly supported by trained medical staff employed by the camp. Fortunately, the camp was situated close to an EMS (emergency medical services) station.
"Personnel attended the scene quickly with immediate defibrillation, achieving the return of spontaneous circulation (ROSC) within 10 minutes of initial unresponsiveness.
The Ontario camp's health response team was activated by radio as emergency medical services were contacted.
Brill said: "The camp physician and two nurses arrived at the scene four minutes after CPR was started.
"They began mouth-to-mouth resuscitation and restarted chest compressions three minutes later after a rapid increase and then cessation in pulse."
Paramedics then applied an automated external defibrillator (AED) eight minutes after the onset of unresponsiveness.
Two shocks were delivered to the girl's chest during an additional two minutes of further chest compressions.
Brill, a professor of pediatrics, said: "The total duration from unresponsiveness to ROSC was ten minutes."
Advanced care paramedics arrived two minutes afterward and secured the unnamed girl's airway via tubes as she was rushed to the local hospital.
She was placed in the intensive care unit (ICU) where X-rays and scans confirmed her diagnosis.
In addition to supportive care, she was sedated and administered intravenous drugs.
When asked about symptoms, she said she had had intermittent palpitations on the morning of her arrest but no previous chest pain or shortness of breath.
She was discharged from the hospital after nine days on a weaning course of steroids. She had a normal neurologic examination with residual short-term memory loss.
On follow-up three months after the arrest, this had resolved and heart scans were normal.
Brill said: "Overnight summer camps are common in Canada, though a specific census has never been done.
"Although injury and illness do occur, medical emergencies are exceedingly uncommon across all age groups.
"Nevertheless, preparation for low-frequency, high-acuity emergencies are needed and should account for remote geography and prolonged EMS response times.
"Paediatric out-of-hospital cardiac arrest is uncommon but may be under-reported owing to inadequate surveillance systems, publication bias or legal concerns."
He added: "This case highlights the importance of early recognition and prompt initiation of effective compressions in the resuscitation of out-of-hospital cardiac arrest, regardless of age."
Doctors around the world have identified an alarming rise in heart attacks among young people in recent decades.
Changes in lifestyle have been blamed including eating too much junk food, spending too much time playing computer games and not getting enough exercise.
The NHS says it is "highly recommended" that every parent or carer goes on a first aid course as it makes CPR much easier to understand and remember.
Studies have shown performing it to the hit Bee Gees disco sound "Stayin' Alive" gets the best results.
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