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UNM debuts new response to cardiac arrest

Dr. Jon Marinaro, chief of critical care at UNM Hospital, explains how a portable extracorporeal membrane oxygenation system works. It replicates the function of heart and lungs. (Roberto E. Rosales/Albuquerque Journal)

Copyright © 2019 Albuquerque Journal

Doctors at the University of New Mexico Hospital have debuted a new technology, the first of its kind in North America, that they expect to dramatically expand the number of cardiac arrest cases that paramedics and other emergency staff can effectively treat.

Last week, doctors from UNM Hospital, alongside Albuquerque Ambulance Service and Albuquerque Fire Rescue hooked a patient up to an extracorporeal membrane oxygenation system, a rare life-support system that simulates the effect of a heart and a pair of lungs to keep cardiac arrest patients alive, in the field.

Darren Braude, professor of emergency medicine with UNM Hospital, said during a news conference Monday that it was the first time a patient had received the treatment outside of a hospital on this side of the Atlantic Ocean, the product of a collaborative effort to make the technology more portable.

While the first patient ultimately died from the cardiac arrest over the weekend, UNM doctors said they were optimistic that the machine would increase the percentage of patients who survive cardiac arrest in Albuquerque by allowing patients who can’t be transported to the hospital in time to receive the same care as those who are.

“We’re trying to get to some of the outlying communities that are a little bit further away,” said Todd Dettmer, a critical care physician at UNM Hospital.

Cardiac arrest, which occurs when the heart suddenly stops beating and cannot pump blood to the brain, lungs and other organs, is a leading cause of death in the United States. Jon Marinaro, chief of critical care at UNM Hospital, said around 30% of people who experience cardiac arrest while outside a hospital survive nationwide, though that number drops rapidly if a patient hasn’t been revived after 20 minutes. He said just 1% of patients who haven’t been revived after 20 minutes survive with their full brain function intact.

Marinaro said extracorporeal membrane oxygenation (ECMO) systems can keep patients alive by removing blood from the right chamber of the heart, pressurizing and oxygenating the blood, and returning it to the patient, simulating the effect of a heart while the heart is stopped.

“This is an advanced procedure that is only available in a few hospitals,” Braude added.

However, Marinaro said patients must be hooked up to an ECMO system within an hour after collapsing. This means that there are areas of metro Albuquerque that are too far from the hospital for patients to be transported in time. Borrowing from a program used in Paris, the three agencies worked to mobilize the ECMO machines and bring them to patients outside that radius.

Chris Ortiz, EMS chief for Albuquerque Fire Rescue, said an AFR vehicle was outfitted with an ECMO system. In the event of a cardiac arrest emergency outside that radius, Ortiz said the truck carrying the ECMO system will meet other first responders onsite. The patient would then be hooked up to the ECMO system and transported to the hospital.

Ortiz added that patients must be between the ages of 18 and 75, and the cardiac arrest must be witnessed by family members or other bystanders.

While Marinaro said the program couldn’t save everyone who experiences cardiac arrest, he said it stands to make modern care available to many more Albuquerque residents. Going forward, the hospital is working to make the program more straightforward and cost-effective, allowing smaller, rural hospitals to implement it as well.

“One of my hopes is … to make it so simple that small places can offer this as well as large places,” Marinaro said.

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