A 90-year-old patient arrived at Overlook’s Emergency Department in February suffering a massive heart attack. Within minutes, she was in cardiogenic shock – a rare, but often fatal, condition in which the weakened heart is unable to pump enough oxygen-rich blood to the body’s vital organs.
This was the case David Bartov, MD, and the Overlook cardiac care team had been preparing for when they set out – nearly two years ago – to establish a multidisciplinary cardiogenic shock program for the early diagnosis and treatment of this select group of patients.
Key to this effort, says Dr. Bartov, director of Overlook’s cardiac catheterization lab, is the Impella – the world’s smallest heart pump. Guided up to the heart through an artery, the Impella temporarily helps move blood through the heart to the rest of the body, allowing the heart muscle to rest, recover and regain function.
“The Impella is an important tool in combating shock,” Dr. Bartov states. “About 50,000 patients present with cardiogenic shock in the United States every year, and a patient’s average chance of survival is less than 50%. If we can make a dent in that, we can increase survival rates to 75-80%.”
Overlook has always been able to provide care for cardiogenic shock patients; however, managing patients with Impella support devices is extremely complicated, and it frequently necessitated transfer to another Atlantic Health System hospital.
That can take additional time and has the added risk of shifting the delicately positioned support device. The COVID-19 pandemic only exacerbates the challenges of transferring patients.
Meeting the Challenge
Hoping to circumvent these factors, Dr. Bartov challenged the Overlook cardiac care team to successfully manage cardiogenic shock patients on-site.
“The sooner we can recognize shock and get these devices into patients here, the better we can manage the disease and de-escalate the amount of support and care they need,” Dr. Bartov explains.
Led by Dr. Bartov, cardiologists, emergency physicians, critical care specialists, cardiac critical care and cath lab nurses, educators and ultrasound technologists all worked for nearly two years to learn to recognize early symptoms of cardiogenic shock and to manage it successfully with support devices.
When the elderly cardiac patient arrived at Overlook’s Emergency Department last February, the team was more than ready to save her life.
After inserting the Impella through her femoral artery and into her heart, the patient’s condition, particularly heart pressure and oxygenation, quickly began to improve. For the cardiac team, it was evidence that their hard work had paid off.
“Reaching this milestone involved the entire team,” says Maria Stratton, RN, nurse manager for cardiology at Overlook. “It is truly a testament to Overlook’s culture of innovation and ability to provide state-of-the-art care to more patients within their own community medical center.”