Trip to NWA results in lifesaving ER visit for Air Force Veteran
Text and photos courtesy of Northwest Health
Thomas Grooman of Nebraska City in eastern Nebraska never guessed that a trip to see family in Northwest Arkansas would end up saving his life. Now he makes frequent trips to the region to see his new cardiologist, Dr. Michael Green.
Grooman knew he had heart disease. A U.S. Air Force veteran, he was diagnosed at a Nebraska VA hospital as having two partially clogged coronary arteries, one at 60% and the other at 30%. He was prescribed blood thinners to minimize the risk of a heart attack being caused by a blood clot blocking one of the narrow vessels.
“When I woke up that morning, I didn’t feel good,” he says. “I was breathing hard and very short of breath. I just didn’t feel right. So I made the decision to get to the closest ER fast.” *
His sister drove Grooman and his wife to Northwest Medical Center-Springdale, a nationally accredited Chest Pain Center. “I remember going through doors, but that’s the last thing I remember. I woke up three days later in the Intensive Care Unit.”
Grooman had experienced a heart attack and gone into cardiogenic shock – a medical emergency in which the heart suddenly can’t pump enough blood to meet the body’s needs. Cardiogenic shock is a complication that occurs less than 10% of the time, but when it does, only about 30% of patients with this condition will survive.
Fortunately for Grooman, Northwest Medical Center-Springdale was one of the first hospitals nationwide to participate in a study to identify the best treatment for people who experience cardiogenic shock after a heart attack.
This multicenter study, dubbed the National Cardiogenic Shock Initiative, was designed to show whether outcomes in cardiogenic shock could improve with the use of standardized best practices including the insertion of a special heart pump to protect the patient during a percutaneous coronary intervention – such as placing a stent to open a blocked vessel.
Interventional cardiologist Dr. Michael Green was the lead investigator locally. When Grooman arrived at the hospital, Dr. Green promptly initiated the protocol, implanting what’s known as “the world’s smallest heart pump” to keep Grooman’s body oxygenated while he opened a vessel that was 99% blocked.
“Approximately 8% of patients who suffer an acute heart attack each year will develop cardiogenic shock. That’s about 60,000 people,” says Dr. Green. “The initial pilot study has shown improvement in survival rates from around 30% to 76%. In recent years, we have seen impressive gains in the treatment of ST-segment elevation myocardial infarction (heart attack), which were treated by primary percutaneous coronary intervention, resulting in a 21% decrease in mortality.
“However,” he continues, “heart attacks that were complicated by cardiogenic shock have not seen similar successes and continue to have a high mortality rate, near 70%. Further, recent trials had not clarified the best strategies in treatment. This very significant study has led to the identification of best practices for treatment that will save lives,” says Dr. Green.
The study was conceived shortly after a new device was approved in April 2016 by the U.S. Food and Drug Administration – a percutaneous transvalvular continuous-flow microaxial MCS device for use specifically in AMI-CS (a mini heart pump).
It is believed this device, and others like it, can play a major role in the care of patients with AMI-CS just as PCI had for STEMI. The National Cardiogenic Shock Initiative provides an algorithm to maintain consistency and reproducibility that may provide insights for future best practices associated with the use of such devices.
The care of patients with AMI-CS is a national issue, declared as a priority by the National Academy of Medicine (formerly known as the Institute of Medicine). Recruitment in clinical trials of CS has historically been difficult, with a low number of enrollees preventing implementation of evidence-based therapies.
Partnering hospital systems in the NCSI study, including Northwest Medical Center-Springdale and Northwest Medical Center-Bentonville, use a defined protocol for treatment of AMI-CS patients. This includes quick placement of the heart pump and PCI to open the blocked vessel(s) as well as right heart monitoring to rapidly reduce the use of inotropes and medications that affect the contraction of the heart muscle.
Grooman is looking forward to the rest of his retirement thanks to the Springdale emergency and cardiac care teams’ fast action, the hospital’s participation in this national study and Dr. Green’s expertise.
“If my heart attack had happened here in Nebraska City, I would not be here today. The closest hospital is 40 miles north. I was really pleased with my treatment and couldn’t have asked for any better.”
*The American Heart Association recommends calling 911 for the best and most immediate care possible.
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