Medical Center a leader in emergency resuscitation careBy Scot Roskelley
Laronda Vassers was 53 and in good health. She was not overweight. She did not have diabetes or high blood pressure. Her asthma was well under control and no longer considered chronic. And yet, one day, after a neighbor picked her up from the “L” after work, her heart just stopped.
“I felt fine. I didn’t have any shortness of breath. And within a block or so of the 69th Street ‘L’ stop, I’m told I coughed, slumped over and was gurgling,” she said.
Vassers’ neighbor took her to the University Medical Center Emergency Room.
Her heart stopped for about 30 minutes. Until recently, physicians believed that anything longer than four minutes would result in brain death, and beyond eight minutes, would result in heart death.
“I saw my medical record and counted the number of times I was defibrillated—11 times,” said Vassers. “There was a doctor in the room who said it was time to call ‘time of death.’ But another doctor said, ‘No, let’s keep going.’ I guess I’m pretty glad he did!”
Vassers, a medical secretary who works for a group of physicians and audiologists at Lincoln Park Hospital, was fortunate she was taken to the University Medical Center, one of only a handful of local hospitals using a relatively new chilling protocol for patients suffering cardiac arrest.
When the heart suffers an arrest, re-starting the heart does not necessarily end a patient’s problems. Over time, researchers have learned that cell death in the heart can continue well after the heart begins beating again. Understanding cell death and ultimately halting or reversing it is one of the things with which resuscitation centers such as Chicago’s are grappling.
Over time, researchers have tried various drugs to halt the process. However, rather than administering drugs, chilling the body after cardiac arrest to somewhere between 89.6 and 93.2 degrees Fahrenheit seems to hold the greatest hope thus far. People who are cooled for 24 hours or more following an arrest seem to have better survival rates and less brain inflammation and damage than those who are not cooled. Nobody knows exactly why.
Although the American Heart Association endorsed hypothermia for these patients in 2003, only about 225 of the more than 5,700 hospitals in the United States have installed machines for inducing hypothermia. And many hospitals that have the equipment do not use it regularly. Ending up in the right emergency room following a cardiac arrest can make a big difference.
Vassers began her journey with ventricular fibrillation, then crashed. Her heart stopped completely. She was quickly cooled, according to the resuscitation protocol. She was unconscious for six days.
“I woke up and was looking at the ceiling, thinking, ‘What am I doing here?’ My memory was gone when I first woke up. When they asked where I lived, I gave them an address from 10 years ago. But after a month, my memory was fully restored. My kidneys gave up, too, and I was put on dialysis. But they also came back fully after a couple of months. The cardiac arrest happened on Feb. 8 last year. I was back to work by April 23.”
David Beiser, M.D., Assistant Professor of Emergency Medicine and the medical center’s champion for cooling comatose cardiac arrest patients, said the Medical Center’s system for cooling patients has improved substantially since the idea was introduced here—both for patients in the Emergency Department and cardiac arrest patients on the floors of the hospital.
He has spoken throughout the medical center about the successes of cooling. Each time the staff has a significant win by cooling a patient, word travels throughout the hospital. He said the mood during resuscitation has improved “because we’re bringing back hearts and brains.”
Few hospitals in the area are cooling patients systematically, Beiser said. Yet the city of Seattle is studying the impact of having paramedics start the cooling protocol in the field, before the patient is even brought to the hospital. It is thought that the sooner patients are chilled, the better the outcome. Beiser added that in parts of Europe and Australia, hypothermia has been widely adopted as the standard of care.
There are several ways to approach cooling patients. At Chicago, patients are given chilled saline for one or two hours, and then are wrapped in cooling pads that maintain the chilled temperature for 24 hours.
Chilling bodies is not the only area of research at the University’s Emergency Resuscitation Center. Researchers there also are studying the genomics of hypothermia, improved therapies for soldiers on the battlefield who have suffered massive blood loss and better ways to perform CPR.
“Ninety-five percent of the time, sudden cardiac arrest results in death,” said Terry Vanden Hoek, Director of the Emergency Resuscitation Center. “If we can work on the public’s knowledge about CPR, and even health care workers’ knowledge of CPR, we can help reduce that fatality rate,” he said.
Caregivers tire out faster than expected when performing CPR, his group has found. One minute into CPR, as the caregiver tires, chest compressions become shallower and farther apart, as are the breaths. Responders perform better trading off in pairs.
Any time a code is called in the Medical Center, a specially trained team is summoned to administer CPR, defibrillation and any necessary drugs. The team has special equipment that provides immediate feedback and records information as patients receive CPR. This team re-convenes weekly under the direction of Dana Edelson, Instructor in Medicine, to review what went well, what didn’t and what they can learn from the experience. As a result, CPR in the medical center has improved significantly.
Until recently, the research effort relied on one specialized automatic external defibrillator with the CPR feedback and a couple of backup units. The equipment was kept in the Intensive Care Unit. Now, the hospital has purchased 36 units, locating them throughout the facility, according to Debbie Walsh, who coordinates advanced cardiac life support training for the hospital’s physicians and nurses.
As members of the ERC team learn more about resuscitation, this information is shared with paramedics and other first responders to cardiac arrest. In addition, team members are taking their knowledge to the staffs of area churches and public gathering spots such as museums, and to residents of public housing groups.
Ellen Demertsidis, Training Coordinator in Emergency Medicine, assisted in pioneering the medical center’s efforts to promote automatic defibrillator use in public places around Chicago. It started in 2000 as a three-year study of 80 sites around Chicago, such as the Goodman Theatre, the Lyric Opera, Adler Planetarium, the Field Museum and an assortment of high-rises, grocery stores and golf courses. At half of the sites, the staff was given CPR training. At the other half, the staff was given CPR training and a defibrillator and training on how to use it.
The study showed defibrillators used in conjunction with CPR to be far more effective at restoring a person’s heart beat.
Thus far, 12 individuals were sent off by ambulance with their hearts beating again. Demertsidis said the feedback from both the patients, as well as those who have used the defibrillators, is gratifying.
Ronn Walldren, a retired police officer who was 63 at the time, was working crowd control outside of the Daley Center for the filming of an episode of ABC Channel 7’s “190 North.”
“It was particularly cold that day,” he said. “I walked back to the TV station to put warmer clothes on. Then, I came back to the Daley Center. I felt fine, and the next thing I knew, I woke up a day-and-a-half later in the hospital. They told me I had a massive heart attack, and that I had to be hit three times with the defibrillator. Everyone told me how lucky I was that they had the equipment right there. I’m very grateful.”
The University Medical Center’s Emergency Resuscitation Center is recognized as a leader in the country for its research, community work and efforts to improve resuscitation at a major academic medical center.