In a heartbeat

When Dianne Cooks suddenly felt weak during a trip to the mailbox, she knew something wasn’t right. The pain was different: It didn’t feel like acid reflux. Cooks was going into cardiogenic shock.

“It’s like trying to steer an oil tanker when the heart starts to fail like that,” explains Dr. Jan Pattanayak of Asheville Cardiology Associates. “You need to have something to support the heart in order to buy yourself enough time.”

Time, however, was not on their side. An ambulance had already transported the retired special-needs teacher from Rutherford Hospital to Mission Hospital, and Pattanayak’s small team (two nurses and two cardiovascular technicians) knew they’d have to work fast.

“When she came in, acid had already started to build up in the bloodstream, and her body was shutting down   her kidneys weren’t working,” Pattanayak recalls. Standard protocol for treating an acute heart attack is to insert an intra-aortic balloon pump. But this case was hardly standard.

The heart attack   her second in three months   was sending her body into shock. According to figures from the National Heart, Lung, and Blood Institute, that gave Cooks about a 50 percent chance of survival.

Limited options

Meanwhile, the fact that Cooks was in cardiogenic shock limited the treatment options.

“That means the heart is unable to keep up with all the demands of the body,” Dr. William Abernethy explains. “Even if we were able to open up the vessel and restore blood flow to help this kind of stunned heart muscle recover, the shock phase doesn’t immediately turn around. It takes awhile, sometimes days, for some [patients] to recover. So we need some sort of tool that will tide someone over,” says Abernethy, who directs Mission's cardiovascular catheterization lab.

At first glance, the Impella 2.5 doesn’t look all that impressive: It’s just a rotary pump embedded in a catheter. But what makes the world’s smallest heart pump unique is its tiny but potent motor, which runs at 60,000 revolutions per minute. With a single 3-millimeter incision near the thigh, this minimally invasive procedure can boost the volume of blood being pumped by about 2.5 liters per minute.

Still, it’s not exactly routine. “It’s an unusual thing, even though it’s technically an easy procedure to do. We use X-rays the whole time   and we put catheters in about 10 times a day,” notes Pattanayak, who’s performed the Impella procedure three times since Mission adopted it two years ago.

The principle is the same as that used when inserting an IV. In Cooks’ case, Pattanayak worked a catheter through the heart’s femoral artery and into the left ventricle, the heart’s main pumping chamber. After activating the Impella device, he inserted coronary stents to keep his patient’s arteries open.

The intra-aortic balloon pump, in use since the 1960s, can also be inserted via a catheter, but it increases blood flow by only about a half-liter per minute. “I’m not confident that would have been enough in this case,” says Pattanayak.

Technology saving lives

Ebony Cooks says she agreed to the unfamiliar procedure for her mother because “I just knew I wanted them to save her life and help her.”

Mission is the only hospital in Western North Carolina that can perform the procedure, says Abernethy, who pushed for adding it to the toolbox for Mission’s physicians.

“Better medicine is not always high-tech medicine, and we really pride ourselves on delivering cost-effective care,” he notes. “So while we want to be early adopters of newer approaches, we’d also like for them to be vetted out to some degree, until we feel it’s time to plunge in.” Cooks’ case, says Abernethy, is a dramatic example of how this technology can help save local lives.

Ebony Cooks, who moved to Spindale from Shelby, N.C., after her mother’s first heart attack in November, believes the procedure saved her mother’s life. “When they told me to go back and say goodbye to her, I just told her to keep fighting, because I need her,” she reveals. “Then my mom looked at me and said, ‘OK.’”

Roughly one month later, the retired teacher says she’s doing more than OK. “I’m hoping to be back on my cane and get off this walker again,” she jokes, adding that she’s not going to push herself too hard.

And though Cooks had never heard of the Impella device before, she now speaks of it with reverence. “I do appreciate and thank God for that machine and those doctors. Maybe they can save another person’s life like they saved mine.”

— Send your local health-and-wellness news and tips to Caitlin Byrd at cbyrd@mountainx.com, or call 251-1333, ext. 140.

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