Friday, October 25, 2019

University Hospitals patient survives pulmonary embolism with double cardiac arrest

A 95 percent mortality rate is incredibly high, but those are the statistics for pulmonary embolism with cardiac arrest. Neal Drown of Avon Lake survived that condition - times two.

On Sept. 11, Drown became unusually tired. He knew something was wrong when he felt strange after climbing the stairs. “I just felt winded and exhausted. I sat down in a chair and felt really weird, faint and light-headed,” he said.
 
It alarmed him so much that he called 911. At first his symptoms seemed like a heart attack, but caregivers at University Hospitals St. John Medical Center determined it was a pulmonary embolism. At the emergency department, Drown then also suffered cardiac arrest – not once, but twice.  

Pulmonary embolism (PE) occurs when a blood clot blocks an artery in the lung. Symptoms vary depending on the size of the clot and how much of the lung it affects, but can include shortness of breath, dizziness, a feeling of anxiety, lightheadedness and sweating. Massive PE without cardiac arrest has a mortality rate of 30 percent, but with cardiac arrest mortality may be as high as 95 percent.
 
At UH St. John, Drown was immediately given tissue plasminogen activators (TPA) which help break down blood clots. He was intubated, given five medicines to raise his blood pressure and put on life support with 100 percent oxygen.

Once stabilized, Drown was transferred to UH Cleveland Medical Center. The hospital mobilized its Pulmonary Embolism Response Team (PERT). The team was developed in 2018 to address the complex treatment of patients with PE. Team members rapidly consult each other and give advice resulting in the most optimal plan for that individual patient’s unique needs.

Mehdi Shishehbor, DO, MPH, PhD, Director, Interventional Cardiovascular Center at University Hospitals Harrington Heart & Vascular Institute and his team were waiting for Drown’s arrival and took him directly to the cardiac catheterization laboratory for percutaneous pulmonary embolectomy. The procedure removes the material blocking blood circulation in the lung. Instead of an open operation through the chest, the physician deploys a device percutaneously (through the skin) in the groin area.
 
Just a few years ago this treatment didn’t exist. Pulmonary embolectomies were not done percutaneously and open chest removal was too dangerous for patients on blood thinners like Drown. But because of advances in less-invasive procedures, Drown could have the embolectomy while on blood thinners. Using this novel technique is not available at every hospital.

“Several things led to our patient’s survival in this case: Immediate treatment with full TPA at UH St. John followed by timely communication with the PERT team. This meant my team was on standby waiting to receive Mr. Drown when he arrived. We were prepared to take any steps necessary including placing Mr. Drown on the heart and lung machine (ECMO). I believe the very timely intervention and clear communication saved his life,” said Dr. Shishehbor.