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Hospitals embrace promising treatment for heart attacks



Published: Mon, June 6, 2011 @ 12:02 a.m.

By CHELSEA MILLER

TheNewsOutlet.org

CANFIELD

Pete Widera remembers last Aug. 30 well.

At first, the signs were slight: tight chest and difficulty breathing. Fifteen minutes later, his wife, Jeanne Widera, 66, had a full-fledged heart attack.

The Canfield man called 9-1-1 and, after his wife was resuscitated, asked Lane Ambulance workers to take her to St. Elizabeth Health Center’s hospital in Youngstown, one of 13 Level I trauma centers in Ohio.

Four months later, Jeanne died.

He now wonders if his hospital choice may have cost Jeanne her life.

“If I knew then what I know now, I would have flown her to Cleveland,” he said.

Widera believes that his wife’s death may have been prevented if a procedure, called therapeutic hypothermia, had been used when she first came to the emergency room.

While it’s not uncommon for grieving family members to make such claims, therapeutic hypothermia is practiced at all 11 Level 1 trauma facilities in Ohio. ValleyCare Northside Medical Center in Youngstown, which is not a Level I Trauma Center, also uses the procedure.

Therapeutic hypothermia is performed with a cooling blanket that reduces body temperature to about 32 degrees, said Dr. Andrew Burger, a cardiologist at the University Hospital of Cincinnati, who uses this procedure. The body temperature is then closely monitored to slow body organs to reduce injury and brain damage.

“The equipment is not complex,” he said. “[Doctors have to]understand how it works, but it’s not hard.”

Although some instances don’t warrant the procedure, such as being brain-dead on arrival or showing no hope of recovery,, Burger said the procedure is usually recommended.

It was unavailable last fall to treat Jeanne Widera.

St. E’s has it today.

In the past decade, therapeutic hypothermia has become a standard of care.

A study published in 2002 in the New England Journal of Medicine reported that 55 percent of the 136 cardiac- arrest patients who received the procedure had a favorable outcome. After six months, cardiac mortality rates were 41 percent in the hypothermia group and 55 percent in the non-hypothermia group.

Since then, the procedure has become widespread in U.S. hospitals.

“Every community, I would hope by now, has a place where they offer this therapy,” said Dr. Michael Mooney, interventional cardiologist and co-director of cardiovascular labs at the Minneapolis Heart Institute.

Dr. Mooney, who has been performing the procedure for six years at his hospital, said, “The American College of Emergency Physicians has come out in favor of it; so has the American College of Cardiology, and so it’s not considered controversial anymore.”

St. Elizabeth officials said that because therapeutic hypothermia was not a “required” standard of care, they did not use it.

The procedure may not be “required,” but several studies have proven the benefits of therapeutic hypothermia, said Dr. Vincent Mosesso, a professor of emergency medicine at the University of Pittsburgh

“I would say over the last couple years, it’s become more and more like a standard of care,” Mosesso said.

THE MEDICARE DEBATE

Jeanne’s final months of life were back and forth between local facilities.

She was admitted to a local nursing home in October, but after breathing troubles, she was readmitted to St. E’s.

Through her ordeal, she was essentially incapacitated, Pete said. She would open her mouth and eyes but was not able to breathe without support. In December, with no hope of recovery, Pete said it was recommended that Jeanne come off life support. Eleven days later, Jeanne died.

St. Elizabeth’s could not comment on her care because of patient confidentiality.

But it would discuss where it is headed with the procedure.

Lisa Parish, vice president of clinical services and supply chain management at Humility of Mary Health Partners, said the hospital has recently begun performing the procedure with a small group of patients.

Tina Creighton, spokesperson for St. Elizabeth’s, said the hospital decided to offer the procedure after other hospitals have proven it to be beneficial.

“After sometimes years of research and observation a procedure can become a ‘best practice’ or standard of care,” she said. “These other options have been tested to be safe and may be useful, but it’s important to remember that there is typically not just one that is the best, or the only option for effective care.”

When Widera was admitted, the hospital offered a procedure called RapidBlue, which is a type of therapeutic hypothermia or heart- attack victims, said Jessica Ulbrich, a representative of St. Elizabeth’s. The hospital also offers passive cooling by placing a cool blanket on the patient.

Patient condition and physician preference determines if the procedure is needed and which type is used, said Parish.

Widera said neither option was given to his wife.

“I’ve talked to a lot of other hospitals, and they have it available. They know Medicare does not cover this, but it’s available to save a person’s life that’s there,” he said. “I was told ... three times (by representatives of St. Elizabeth’s), that this system is not cost-effective and Medicare won’t cover it.”

Creighton said coverage of the procedure depends on the insurance plan or provider, but the hospital provides care regardless of a person’s ability to pay.

Dr. Mosesso said in Widera’s case, he would have transferred her to Northside Medical if it meant the procedure would be performed.

“I would recommend that if the person had sudden cardiac arrest and was resuscitated, that they should be transported to a hospital that has a program for post resuscitation, including therapeutic hypothermia,” he said.

While the procedure is not available at every hospital, those who have suffered from cardiac arrest should be transferred to a hospital that performs it, Dr. Mooney said.

He also stressed there should have been better communication between the hospital and the ambulance taking her there.

“The problem may really have been with the EMS system — to not know that they need to ... take these patients to the right hospital,” Dr. Mooney said.

Randy Pugh, chief operations officer for Lane Ambulance, said his crew takes the patient to the hospital of the family’s preference, with the exception of trauma victims. Pugh said Lane offers recommendations, but must follow the patient’s wishes.

“Patients who have had cardiac arrest, particularly if it’s not traumatic, should in my view, be brought to centers who offer therapeutic hypothermia,” Dr. Mooney said.

The NewsOutlet is a joint media venture by student and professional journalists.


Comments

1gingerspice(114 comments)posted 3 years, 1 month ago

Being there is such a turn over with ambulance personnel, perhaps better orientation programs(and wages) be instituted so the personnel can be better informed on what proceedures are offered at which hospitals and suggest this to the families; still leaving the final decision of where to take the patient up to the family member.Family members are usually in a panick and /or don't know the best facility for required treatment.

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2lumper(281 comments)posted 3 years, 1 month ago

God Bless this man for speaking out about the atrocious care provided by st. e's. st.e's advertises well and has a nice menu and big tv's at mcclurg road , but that is not health care. "they'll provide a cool blanket", how about throwing cold water on somebody and turning on a fan- that shouldn't cost too much.

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3maxi(71 comments)posted 3 years, 1 month ago

Who couldn't empathize with this man who lost his life partner. So sad. My heart felt condolences to her family.

This story needed more research and should have had more seasoned journalists reporting this story (really, Vindy? A hospital that pays you tens of thousands in advertisement and you slap them in face with a student journalist? I'd cancel every one of my ads with you if I were the CEO, there are other forms of advertising these days). Shame on the Vindy for portraying St. E's as antiquated and incapable. St. E's is known for its cutting edge heart care and it's a hospital that has saved countless lives in our valley. Kudos to St. E's for saving the lives of my family members. One is 85 years old today and lives independently. Oh, and yes, he's had 3 heart attacks, 2 open heart surgeries, and now has a defibrillator (thank you Dr. Hoffman and Dr. Raheja). Did I mention how wonderful their CHF program is? And thank you St. E's for caring for my family and friends for decades in other areas of your hospital.

And for facts on quality care and saving lives go to the public hospital reporting sites (the Vindy's student journalist and other journalists who assisted on this story didn't think to do this). They would see that the amazing heart care provided at St. E's speaks for itself.

As sad as this story is, I do not believe it was worthy of a headline story, nor do I believe it was worthy to focus on this one procedure only. There is more to saving heart attack victims than theraputic hypothermia. Could you Vindy, focus on the hundreds of thousands of lives St. E's has saved? Or is that NOT a story?

And to the Vindy, a story as deep as this, don't leave it to your students in training. Let them shadow instead.

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4walter_sobchak(1849 comments)posted 3 years, 1 month ago

What is interesting to me is that a Level ITTrauma Center would not use a procedure that has become widely accepted by the cardiology establishment and has only minimal risks associated with it. Kudos should go to the oft-maligned Northside Medical Center for being in the lead in emergency care for the people of the Mahoning Valley and recognizing that the best results for cardiac patients start with good ER practices and protocol.

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5maxi(71 comments)posted 3 years, 1 month ago

@Walter,
I am thankful that St. E's waits to use a method where the safety and efficacy has been proven. THEN it becomes a standard of care.
Theraputic hypothermia is not the first method of saving a life and it is not the only method. If the method is warranted, it needs to be implemented shortly after the heart attack, not much later.
Again, since many of you claim to state you know practices and protocols I invite you to go to the hospitalcompare website for quality statistics. This is a public site. Then you will find out how your local hospitals fare. But then again, this will always be a community divided. North vs. St. E's.
Walter, may I ask you to justify why North is the leader in ER care in the Mahoning Valley? Specifically, what are you basing that on? What do you mean by best results? Based on what? I'm curious to know.
You might get seen quicker at North there but that should tell you something...they are not as busy. The rest of the valley has chosen to go to St. E's and St. E's Boardman on McClurg.

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6steelhead(123 comments)posted 3 years, 1 month ago

Several Fire Department and Private EMS providers in this area have been pushing for Post-Arrest Hypothermia for years. In fact, many of us have gone out on a limb and with the approval of our medical directors, implemented the protocols. This is not an expensive venture and can and should begin as soon as possible after a patient regains a pulse. In the ambulance, saline can be kept cool with a cooler and ice packs. That's what Pittsburgh EMS does. At the department I work for we use a refrigerator. Two years ago when St E's was approached about this therapy, they were their usual rude and dismissive selves. Truth be told, St E's is behind the times. Also, in multiple studies of Post-Arrest Hypothermia there is no difference in the survival rates. There is however a HUGE difference in reducing neurological defecits in the survivors, making dramatic differences in the quality of life.

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7lumper(281 comments)posted 3 years, 1 month ago

maxi, if you know anything, you know that the hospitals all pay for the surveys and no contracted surveyor will be critical or not show their "employer" in a positive light. st. e's manipulates statistics by shipping their dying patients to assumption and other affiliated centers to avoid bad stats. you want heart care , the best in the world, is 90 minutes away at the cleveland clinic. get stabilized at northsides er, then transfered to the cleveland clinic.

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8walter_sobchak(1849 comments)posted 3 years, 1 month ago

Maxi,
Everyone knows that St. E's is concern about health; that is, the health of the bottom line and they constantly divert the sh!t patients to Northside. Ask any EMT for the truth on this. Steelhead and Lumper are correct. The last thing St. E's wants is people dying in their ER so their statistics look good. The last thing they want to hear from an EMT over the radio is black male GSW. Divert to Northside since he won't have insurance. But, if you want quality heart care, you go to Clev. Clinic or Allegheny in Pitts.

And, the studies on this procedure have been available for 10 years. This is my way of sticking it to the snobs at St. E's that a Valley Care hospital (no longer forum) was one up on them!

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9steelhead(123 comments)posted 3 years, 1 month ago

Walter-just to be clear, since St E's is a Level 1 Trauma Center, they cannot and do not divert traumas. I just want to be fair. By law, EMS has to take trauma pt's to the appropriate facility, and on paper, that is St E's. I personally think that the same should apply to strokes, heart attacks, etc. If a facility is more adept at taking care of a certain type of pt, then in the acute setting, that is where the pt should go. St E's policies actually hinder the care a pt gets in the field, and the protocols they are trying to push on EMS around the area are archaic at best. The treatments they want us to use for CHF have been PROVEN by the American Heart Association to be detrimental to the pt. The pain relief for trauma pt's they want us to use is also PROVEN to be detrimental to the pt. I and several other departments have tried for years to get them to see the light, but we are just a bunch of ambulance drivers, what do we know? They need to go to Allegheny General or UH and watch how real trauma teams work in concert with EMS and get the best possible results for the pt. Instead, they seem to go out of their way to alienate EMS and make our job ten times harder than it needs to be. It's not the nurses' fault, it's the head of the ER and administration that seems to enjoy keeping their employees po'd, which rolls downhill of course, and eventually does affect the care. I would love to see St E's change to a facility where I and my colleagues were comfortable taking pt's there, but I have stopped beating my head against that wall. Unless I was shot in the chest, I don't think I would go to that ER.

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10walter_sobchak(1849 comments)posted 3 years, 1 month ago

steelhead,
Yes, I stand corrected. My use of a GSW was wrong and as a Level I Traun=ma center, they cannot divert THOSE types of patients. But, (wink, wink) I think you know where I am coming from.

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