Collaboration is Key: UH’s Innovative Shock Team Saves Lives
The morning of Nov. 8 started like any other for 55-year-old Richard Mack of Amherst. He told his wife, Melissa, that he was heading outside to rake leaves in their yard. Soon thereafter he began to feel severe pain in his chest. Over the following three weeks, extraordinary measures would be used to save Richard’s life, demonstrating the power of advanced care and collaboration.
“When he came in the house, I could tell something was wrong,” said Melissa. “His face was gray and he was sweating profusely. He said that I needed to take him to the ER and that’s exactly what I did – very quickly.”
On the way to their local emergency department, Richard passed out. Upon arrival, staff began chest compressions while he was still seated in his truck.
Richard was suffering from a “Widow Maker” heart attack, named for its severity and the high numbers of deaths attributed to it. To restore blood flow to his heart, he underwent two heart catheterization procedures. But Richard was in cardiogenic shock – a condition in which the heart cannot sufficiently deliver oxygenated blood to the body’s organs – which required highly specialized quaternary care.
That’s when the UH Shock Team was called.
Shock Team Activated
Initiated in mid-2018, the UH Shock Team is a multidisciplinary team of clinicians who provide a collaborative approach to the longitudinal (from onset through long-term follow-up) care of patients in cardiogenic shock. The team comprises UH specialists in the areas of emergency medicine, critical care, interventional cardiology, heart failure and cardiac surgery, as well as expert physician assistants, nurse practitioners, nurses and respiratory therapists.
On-call team members are activated through a single phone call to the UH Transfer Center. Calls are initiated by referring providers from hospitals or freestanding ERs within UH or outside of the system, as was the case with Richard. These calls immediately trigger a specialized nurse to place a call to the Shock Team. While on that call, team members listen to the nurse’s description of the patient’s condition, then determine the best course of action through pre-established algorithms.
“We’ve conducted outreach both within the system and to cardiac programs outside of UH,” said Michael Zacharias, DO, FACC, Medical Director of Mechanical Circulatory Support, UH Harrington Heart & Vascular Institute. “By informing referring physicians of the quaternary care available at UH Cleveland Medical Center, we are saving lives that may not have been saved before.”
In Richard’s case, the UH Shock Team determined that he needed mechanical circulatory support in the form of extracorporeal membrane oxygenation (ECMO) as well as the Impella™ heart pump – a percutaneous (through the skin) mechanical device.
He was flown via helicopter from Lorain to UH Cleveland Medical Center, where Alan Markowitz, MD, Chief Surgical Officer and Interim Chief of Adult Cardiac Surgery for UH Harrington Heart & Vascular Institute, implanted an Impella pump into Richard’s heart and initiated ECMO. Both are designed to alleviate stress on the heart of a patient who has experienced a severe cardiac event.
“The ECMO procedure involves a machine that re-oxygenates and removes carbon dioxide from a patient’s blood and recirculates it back into their body,” said Benjamin Medalion, MD, Surgical Director, Mechanical Circulatory Support and Surgical Co-Director, Advanced Heart Failure & Transplant Center, UH Harrington Heart & Vascular Institute. “The oxygen-rich blood helps heal the body and gives the patient’s heart a break, thus assisting in recovery.”
From Intensive Care to Recovery
For two weeks, Richard remained in the cardiovascular intensive care unit at UH Cleveland Medical Center. Both the Impella heart pump and ECMO were used in his care, with outstanding results. On Nov. 22, Richard was moved to a “step-down” unit to continue his recovery, then went home on Nov. 28 – almost three weeks from the date of his heart attack.
“All of my doctors and nurses were great,” said Richard. “When I woke up, Dr. Lytle explained everything that happened to me and how my treatment was going – he was so polite and considerate. My wife had so many questions, and he took the time to answer every one.”
According to Francis (Ted) Lytle, MD, Medical Director, Cardiothoracic Intensive Care, UH Harrington Heart & Vascular Institute and Division Chief, Critical Care Medicine at UH Cleveland Medical Center, “The cardiogenic shock program emphasizes the collaboration of ‘the team,’ and Mr. and Mrs. Mack were active members of the team. They asked excellent questions and listened thoughtfully. It was an honor to care for Mr. Mack, and we could not be happier with the outcome.”
“It was amazing how the UH doctors and nurses worked together to care for Rich,” said Melissa. “The collaboration among this team is incredible – I know they saved Rich’s life. We feel incredibly blessed.”