ECMO: Saving Hearts
Only one out of every 10 people who suffer cardiac arrest outside the hospital will survive. One man we talked to beat incredible odds when his heart stopped beating.
James and Barbara Manzi have been dancing together for 25 years. It started the day they met!
Barbara told Ivanhoe, "We danced one dance, and he looked down at me and said, I'm never going to let you go."
But a few months ago, Barbara thought she was going to have to let her husband go, when he suffered a massive heart attack.
"I collapsed at the table" James said.
Barbara explained, "They said; don't get your hopes up lady, because this isn't good."
James was rushed to the ER where doctors shocked his heart- 29 times!
"My heart just stopped. I died twice" James told Ivanhoe.
After that, James was in no shape to get the stenting procedure he needed, so doctors tried something different. They put him on an extra corporeal membrane oxygenation machine, or ECMO, to let his heart rest.
William Suh, MD, Interventional Cardiologist at UCLA told Ivanhoe, "ECMO is actually able to take over the function of both the heart and the lungs."
ECMO takes blood from a vein in the heart, oxygenates it and pumps it back into the body. After three days on ECMO, James' condition improved and he was able to have a stent put in his heart.
Eric Savitsky, MD, Professor of Emergency Medicine at UCLA told Ivanhoe, "Without the ECMO, he would have died."
Now, he's back to dancing and loving every minute with his wife.
Barbara exclaimed, "Oh god, he's an adventurer all the time!"
James said, "I feel wonderful!"
ECMO is typically used in patients waiting for a transplant or to protect the respiratory systems of babies born prematurely. Doctors say the device is only an option for select heart attack patients and more studies need to be conducted to confirm its effectiveness. Not every hospital is equipped with an ECMO machine.
Contributors to this news report include: Cyndy McGrath, Supervising Producer; Marsha Hitchcock, Field Producer; Cortni Spearman, Assistant Producer; Rusty Reed, Videographer and Jamison Koczan, Editor.
BACKGROUND: Cardiac arrest is the sudden or abrupt loss of function to the heart. Each year more than 420,000 cardiac arrests occur in the United States and only one out of every 10 patients survive a cardiac arrest outside of the hospital. The condition is so dangerous because it can occur unexpectedly, either instantly or shortly after symptoms begin to appear. While different from a heart attack, cardiac arrest is caused when the heart's electrical system malfunctions. Death from cardiac arrest occurs when the heart suddenly stops working properly and is usually caused by arrhythmias; abnormal or irregular heart rhythms. A heart attack, or myocardial infarction, differs from cardiac arrest in that it can cause cardiac arrest and sudden death. Heart attacks themselves are caused by a blockage that stops blood flow to the heart.
SYMPTOMS OF CARDIAC ARREST:
- Sudden loss of responsiveness or consciousness
- No pulse or heartbeat
- Racing heartbeat
- Chest pain
- Shortness of breath
- Nausea or vomiting
NEW TECHNOLOGY: ECMO, or an extracorporeal membrane oxygenation machine, involves the use of a sophisticated pump that can take over the functions of the heart and lungs during cardiac arrest. The machine essentially breathes for the patient by pumping oxygenated blood to vital organs in the body so that the lungs can rest, helping reduce stress on the heart. ECMO is an uncommon type of intervention device that is usually used to support adults in cardiac failure who are waiting for heart transplantation or to help protect preemie infants' delicate respiratory systems. Doctors at UCLA are developing a protocol for the appropriate use of ECMO for select heart attack patients in the emergency room setting in order to hopefully lead to a better survival rate in those who come to the hospital in cardiac arrest.
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Eric Savitsky, M.D., Professor in Emergency Medicine and Pediatric Emergency Medicine at the University of California, Los Angeles, and talks about a new machine that can help save heart attack patients lives.
Interview conducted by Ivanhoe Broadcast News in November 2014.
You were in the emergency room when Mr. Manzi came in?
Dr. Savitsky: I was, yes.
Tell me what happened.
Dr. Savitsky: Mr. Manzi was brought in by paramedics after collapsing, which is a relatively common event, Occasionally we get patients who collapse as a result of a cardiac arrest or near cardiac arrest and presumptively it's because they've had a heart attack or in the process of having a heart attack. When we received this call the scenario was described as "an elderly gentleman who had collapsed and was hypotensive". On arrival to the ED he had minimal vital signs, meaning the paramedics were having to do a lot of artificial interventions, life support interventions to maintain his blood pressure including CPR, and electrically shocking his heart back into a rhythm that's compatible with life.
Without the ECMO, how would you normally treat him?
Dr. Savitsky: Without ECMO, Mr. Manzi would have died. He's an individual that when he came in, we did all the typical life-saving interventions. One valuable technology we now utilize is bedside ultrasound to evaluate incoming patients. As we were doing all of the typical interventions which include giving epinephrine, and other types of drugs that make the heart work faster and beat more vigorously and supporting the patient's respirations, so breathing for him or helping him breathe and giving him fluids that basically help sustain blood flow to his brain and to his heart, the ultrasound machine allowed us to visibly see his heart and see how his heart is responding to these interventions. Coupled with us performing a series of interventions that normally help restore blood pressure and in his case, his heart really wasn't responding in a favorable way because we had to shock him electrically to restart his heart and after every event, we could see his heart was getting weaker and weaker on the ultrasound screen.
We could trend out over 15 or 20 minutes that all the things that we typically do to help bring a patient back were not going to work. Mr. Manzi was responding each time, but then he would relapse back into a heart rhythm that was not compatible with life. The ultrasound images were showing that the heartbeat was progressively getting weaker by the minute. There was also some electrocardiographic EKG evidence that the underlying process was a heart attack, that's what precipitated two or three courses of action; one was reaching out to our cardiology service to come evaluate him for possible emergency cardiac intervention where they can open some occluded arteries; the other was notifying the ECMO team that could potentially support him, and serve as a bridge to having a cardiac intervention and the third thing was continuing to do everything that we normally do to support him, as we're trying to get some people that ultimately could save his life.
And you said the ECMO is not a common course of action?
Dr. Savitsky: There are some isolated case reports and some small case series that have shown how ECMO can be used for a variety of emergency department interventions. ECMO is typically used to support someone through what otherwise would be a fatal event as a bridge to some type of definitive care whether it's letting their body recover from an infection or drug toxicity or if it's a bridge to a potential cardiac intervention that could ultimately be life sustaining. It's a bridge to therapy. It's been used anecdotally in multiple different settings but it would be classified as an experimental or research type of intervention for a lot of commonly encountered conditions.
Do you think it's going to become more common?
Dr. Savitsky: It's very common in an in-hospital setting. It's routine in the operative setting. In an emergency department setting, where you see undifferentiated patients, patients who have just succumbed to an illness, it's still pretty unusual. I think there needs to be a fair amount of research to use it judiciously. It works. It's effective in serving as a bridge to therapy. Ultimately what makes Mr. Mani's case really unique, is in 20 years of practicing medicine, he's one of the handful of patients that given his age, the severity of his underlying illness, given how long he had to be resuscitated, I have seen walk out of the hospital neurologically normal, or near normal. This was amazing. Defining appropriate use cases for ECMO technology is where future studies are going help. To routinely use it and apply it on every patient in cardiac arrest is not necessarily the way to use it. Defining which subset of patients are good candidates for this type of intervention is an important future step.
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
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