NYP Brooklyn Methodist

A A HEART ATTACK was the furthest thing from Robert's mind on that February day. Young, healthy and active at 39, he'd never had chest pain or any other signs of heart trouble. "My father had a heart attack when he was young, but I never suspected anything was wrong with my heart," Robert says. "I work out three or four times a week and walk a lot—like most New Yorkers." That day, Robert was walking to his home in Park Slope after seeing his personal trainer when he collapsed in the street. He remembers falling, but nothing that followed. Later, Robert would find out that his heart had stopped beating, and two off-duty emergency medicine technicians (EMTs) who found him stepped in to try to save his life. QUICK THINKING The EMTs called 911 and began performing cardiopulmonary resusci- tation (CPR) on Robert, forcing air into his lungs in an attempt to oxygenate the blood traveling to his vital organs. He was transported by ambulance to New York Methodist Hospital where the Emergency Department's (ED's) team began trying to revive him, using an automatic chest compression device to continue CPR. Robert was unresponsive and began entering cardiogenic shock—his organs were no longer receiving enough oxygen to survive. Recognizing the signs of serious heart failure and knowing that time was precious, the ED team reached out to a one-of-a-kind group of experts who could give this man a chance to live—the Hospital's extracorporeal membrane oxygenation (ECMO) team. "ECMO is the last chance for patients like Robert," says Iosif Gulkarov, M.D., lead cardiothoracic surgeon on the ECMO team. "If we intervene quickly, we can bypass the failing heart and the lungs using a heart-lung machine. Blood leaves the body, cycles through the machine, which adds oxygen to it, and then is pumped back into the body so that vital brain tissue and other organs can survive." IN GOOD HANDS ECMO is an intensely sophisticated and advanced protocol that must be started as quickly as possible in heart attack patients like Robert. In order for it to work, the rare combination of the right people, equipment and interventional capabilities must be on-site. Balancing the blood flow, administering the right medications to stabilize a patient and responding to changes in heart function require a highly-trained, highly coordinated group of expert medical providers who know the procedure and can respond at a moment's notice. Fortunately for Robert, NYM is one of the hospitals with all of these elements in place. The NYM ECMO team includes cardiothoracic surgeons, cardiologists, intensivists, perfusionists, critical care nurses and a team of supporting medical providers who assist with the constant monitoring and adjustments necessary to keep ECMO patients like Robert alive. The NYM ECMO team has experience and speed on their side. When the call went out to mobilize for Robert's case, they sprang into action, collecting the necessary equipment and medications and moving to his bedside in the ED. There, Dr. Gulkarov expertly maneuvered a thin tube into place to direct blood away from Robert's body and into the special heart-lung machine where oxygen was added. Another tube went into his blood vessel, carrying freshly oxygenated blood to his brain, organs and the rest of his body. "ECMO is a game changer," says Stephen Peterson, M.D., chair of the Department of Medicine at NYM. "It lets us pull people back from death's jaws and give them a chance to live again." The procedure allowed Robert's heart to rest, giving doctors time to thrive thrive thrive thrive thrive thrive FA L L 2 016 / / W W W.N Y M.O RG 14 T O U C H I N G B A S E

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