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Hypothermia Technology and Cardiac Response Team at St. Mary Contribute to an Amazing Recovery

LANGHORNE, Pa., June 15, 2011 – Mark Harhigh, of New Hope, has an amazing story of survival and recovery that, as luck would have it, attests to being in the right place at the right time. “Less than 10 percent of patients who experience an out-of-hospital cardiac arrest survive,” says Dr. Bindu Kansupada, one of the team of cardiologists who provided care for Harhigh after he was brought to St. Mary Medical Center on April 17, 2011. And to beat those life-defying odds, Harhigh would need all the advantages of technology and advanced care rendered through AED resuscitation, a cardiac emergency response team, a diligent door-to-balloon time, and innovative therapeutic hypothermia.

Before the complete cardiac arrest on the trip to the hospital when his heart stopped beating and he was not breathing, Harhigh did not think he had any real heart problems. A year previously, he had numbness in his hands and arms, along with swelling in his feet, and was referred for a nuclear stress test, but that test did not indicate any significant problems, and he did not believe he had anything to worry about at his relatively young age. But as a 45-year-old smoker with high cholesterol and a stressful job, there were some risk factors present.

“Then one day, I felt some tightness in my chest while I was washing the car, and told my wife I thought I should go to the hospital,” Harhigh says. “She wanted to call an ambulance, but I did not think it was life threatening and asked her to drive.”

It is a 10-mile drive from the Harhigh home in New Hope to St. Mary Medical Center in Langhorne. During the trip, Harhigh passed out and was unresponsive somewhere along Taylorsville Road near Washington Crossing. His wife, Gina, frantically called 9-1-1. The Upper Makefield Police arrived first. They could not detect a heartbeat or any breathing sounds, so they used an AED (automated external defibrillator) to deliver a shock that restarted Harhigh’s heart. Emergency responders stabilized him for transport and notified the Emergency Department at St. Mary.

However, an important piece of information was unknown; no one was really sure how long he had been in cardiac arrest, and how long his brain and body had been deprived of oxygen. Generally six minutes is considered the critical window for resuscitation before irreversible brain or heart damage can occur. Dr. Kansupada, who has been a cardiologist at St. Mary for more than 27 years, says Harhigh had a rupture of plaque and clot formation in the Left Anterior Descending (LAD) artery, commonly referred to as the widowmaker. Fortunately for Harhigh, St. Mary Medical Center is among the most successful hospitals nationwide in performing emergency angioplasty within the optimal time frame in response to a heart attack, and averages well below the recommended 90-minute door-to-balloon time (time of arrival at the hospital to the time a balloon catheter restores blood flow). Harhigh was quickly evaluated, intubated to assist his breathing, and transferred to the cardiovascular catheterization lab where a specialized team was prepared to perform a life-saving emergency angioplasty.

Dr. Mrugesh Patel, the interventional cardiologist who performed the angioplasty, says Harhigh had a complex blockage of the LAD and was lucky they were able to open the vessel so quickly. “And fortunately, I was able to use a drug-eluting stent to make sure this important main artery would not close again,” adds Dr. Patel. In an angioplasty a catheter is inserted into an artery and advanced to the heart, and into the narrowed or blocked artery. A balloon-tipped catheter is inflated to clear the plaque and restore blood flow. A separate catheter is used to place the drug-eluting or medicated stent to act as a scaffold to keep the artery open. The medication on the stent decreases scarring in the healing process, helping to keep the artery open.

The blockage had been cleared in Harhigh’s heart and circulation was restored, but Harhigh’s recovery was not yet certain. The spontaneous movement of his hands and feet and with low blood pressure when he first arrived at the emergency room can be indicators of reversible brain damage, says Dr. Kansupada. Critical Care Specialist Dr. Rakesh Patel was consulted and therapeutic hypothermia was recommended.

Therapeutic hypothermia is used to reduce the brain’s need for and use of oxygen after cardiac resuscitation, and to minimize the damage caused by certain proteins and enzymes that are released in the brain after blood flow is restored. “The inflammation and damage to the brain begins to happen as soon as circulation is restored,” says Dr. Rakesh Patel. “Hypothermia treatment works to stop that injury process.”

Harhigh was placed in a medically induced coma as a machine pumped chilled water through polymer wraps on his legs and torso. Specially trained critical care nurses continuously monitored his low heart rate, balancing the body’s response to effects of hypothermia against pathologic indicators of permanent heart or brain damage.

“The body goes through multiple changes when a patient is placed in hypothermia,” says Cindy Labonski, CCRN, who was part of the cardiovascular care team providing critical care to Harhigh. Harhigh was sedated and placed in hypothermia for 24 hours after which time the equipment is removed and the body is allowed to return to normal temperature passively, meaning nothing is done to speed up the warming time, Labonski explains. The sedation medication also is slowly decreased to gradually bring the patient out of the coma. “But no one knew what condition he would be in when he woke up,” Labonski adds. “It was an area of uncertainty.”

“The doctors told me there might be brain damage,” says Gina Harhigh. “It was all happening so fast. But you know what, Cindy told me, ‘Talk to him, he can hear you,’ and when I would speak to him, you could see his heart flutter on the monitor screen.”

Everyone agrees Mark is a fighter. “Even before he was fully awake, he tried to throw his legs over the bed and get up. It is remarkable that he recovered so quickly and was so intact,” Labonski says. Gina was encouraged that Mark soon responded to instructions to raise his arms or move his legs, and eventually answered detailed questions correctly. “He still does not remember anything about that day, or many of the days following, but he’s back – to normal,” Gina says.

Recent tests indicate that his heart has a normal range of function, says Dr. Kansupada. “I tell him he needs to take some precautions, but he should not consider himself a ‘heart patient.’ That was history, go live a life – happy and productive.”

Some of those precautions do include moderate lifestyle changes. Nutritional counseling, smoking cessation and stress management are part of the cardiac rehabilitation program Harhigh is enrolled in at St. Mary. Rehab exercise sessions are medically supervised and include EKG, blood pressure and heart monitoring. Although Harhigh admits he was not exercising regularly before, and the pace of the workouts is within the guidelines for someone recovering from a recent cardiac event, he says, “I think they go too easy on me. I could do more.”

The Harhighs appreciate that the appropriate resources were there to respond so quickly and effectively to a life-threatening cardiac emergency. “It’s a great story, from start to finish,” says Mark Harhigh. St. Mary has a committed team and level of response designed for saving lives. The ability to rapidly respond and treat, followed with hypothermia therapy serve to increase the chance of survival for those who experience cardiac arrest. “St. Mary has always been in the forefront in implementing guidelines that expedite better outcomes for patients in need of critical care, such as Mr. Harhigh,” says Dr. Kansupada. “It is important to let the community know these resources are available to them when and if they need them.”