By CHELSEA MILLER
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.
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