A healthy young woman walks into the emergency room short of breath, suffering from swine flu. Soon her organs begin to fail and she goes into cardiac arrest.
Only one machine can save her, but the hospital doesn’t have one, and she’s too unstable to go a medical center that does. So, in a desperate effort to save her, some members of her medical team build the machine as the others perform CPR to keep her alive.
It could be an episode of “Grey’s Anatomy” or “ER,” but this drama was very real for a patient at Penrose Hospital, who is now recovering at a Denver hospital.
Although Penrose officials won’t reveal her name or age because of privacy laws, they were willing to share the amazing tale of her life-saving treatment — an almost perfect blend of expertise, timing and luck.
A heart infection
The woman, who is in her 20s, walked into the ER about a week and a half ago. She’d had flu-like symptoms for a couple of days, and her breathing was becoming more difficult. After being examined, she was given medication. Respiratory complications resulting from serious cases of H1N1 flu — she later tested positive for the virus — are not uncommon, after all.
What wasn’t apparent, though, was that the virus had attacked her heart. Her breathing suffered, because the lungs were filling with fluid as her heart failed..
Within eight hours, the woman went from walking to dying. Her lungs and kidneys failed, according to Dr. John Mehall, the hospital’s director of cardiothoracic surgery. She went into cardiac arrest, and was brought back with CPR.
Myocarditis, in which a common virus unexplicably turns on the heart of an otherwise healthy person, is rare but serious. Mehall said patients suffering from it usually face two options: specialized life-support that can pump their heart until the infection passes, or a heart transplant.
Penrose was equipped to do neither.
Mehall’s plan was to get the woman to the University of Colorado Hospital at Denver, which does heart transplants. As he explained this to her husband, a second cardiac arrest occurred.
“The only options were for us to put her on mechanical life support here or pronounce her dead,” Mehall said.
The problem was, such life support for adults — known ECMO — is found only at a handful of hospitals in the country. Penrose has mechanical heart-and-lung equipment for surgical patients, but they’re designed only to work for the hours needed to perform surgeries, not the days needed to outlast a severe infection.
After an hour of CPR, the woman’s heartbeat was restored once again and she was taken to the operating room and hooked up to one of the surgical heart-and-lung machines, which temporarily stabilized her.
By now, more than a dozen people had become involved, including three doctors, 10 nurses and three profusionists —technologists who specialize in life-support equipment.
While some of the staff kept watch over the patient, Mehall and others began the unusual task of trying to build an ECMO machine.
“What we basically did was use the existing parts of heart/lung technology and reconfigured them into a machine that could support this girl,” Mehall said.
The woman benefited from two strokes of luck. About a month earlier, Penrose had ordered special parts for an ECMO, and the hospital’s profusionists had taken a dry run at assembling one in anticipation that an H1N1 patient’s lungs might fail, Mehall said. That first attempt made building it in a time of crisis much smoother.
Secondly, Mehall, had experience with both heart transplants and the ECMO device in children before coming to Penrose, a skill set that’s rare for a community hospital.
Once the patient was stable and taken to the Intensive Care Unit, blood markers were taken to assess the damage to her heart. They were about a thousand times higher than those of a heart attack victim – numbers Mehall never thought possible.
The patient was later taken to the University of Colorado at Denver in case the heart could not recover, Mehall said, but so far that hasn’t been the case.
Mehall has treated thousands of patients, but few of their stories are as gratifying and dramatic as hers, he said.
“You have a young, healthy person who you are able to save their life in a time of acute crisis and who has the opportunity to recover and return to a normal life again,” he said.
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