New program at Sharp Grossmont saves veteran’s life

Casandra Martinez was a nervous wreck as she pulled into the parking lot of Sharp Grossmont Hospital’s Emergency Room. The doctor on the phone with her calmly and clearly explained that her father’s health was rapidly declining, and she needed to make a decision about whether or not to put him on life support.

In the emergency room, staff were working diligently to resuscitate her father, Charles Martinez, age 74, who had arrived by ambulance. Prior to arriving, Charles had been experiencing chest pain and then suddenly collapsed without a pulse. The Marine Corps veteran was in cardiac arrest caused by a sudden blockage of blood flow to his heart, a condition known as acute coronary syndrome.

Extraordinary care amid grave concern

In those stressful minutes that ticked by in the emergency room, Casandra, though distraught, was mindful of the compassion that everyone showed her, even as they feverishly tried to save her father’s life. “The surgical ICU nurse, Lorrie, met me at the emergency room entrance and was there for me and my family from the very beginning,” she says.

“When Mr. Martinez arrived by ambulance, our team of physicians, nurses, technicians and pharmacists all stopped what we were doing and came together,” says Dr. Ashraf Kasto, an emergency department physician affiliated with Sharp Grossmont Hospital who was part of the team of clinicians that helped Charles. “As one well-oiled machine that day, we did everything we could to prevent him from dying.”

Casandra witnessed firsthand how the care team was rallying around her father. Due to his unexpected loss of heart function, Charles’ blood pressure was dangerously low. He was not breathing and was unconscious. “I remember they had to use the defibrillator to resuscitate him at least eight times,” she says.

A lifesaving decision

Charles’ heart was experiencing abnormal heart rhythms, known as ventricular fibrillation. These dangerous rhythms prevented his heart from properly pumping blood to his body and brain.

After consulting with the medical team, Casandra made the decision to put her father on a type of life support machine called extracorporeal membrane oxygenation (ECMO). Her father’s heart and lungs could have a chance to rest and heal as the machine took over the job of these organs, pumping oxygen throughout his body to keep him alive.

“Normal medications or defibrillations were not working,” recalls Chris Stirk, ECMO coordinator with Sharp Grossmont Hospital.

According to Dr. Kasto, Charles’ neurological responses were still intact, as indicated by his ability to actively move his arms and hands, despite his condition. This, along with other indicators, meant that he was a good candidate for ECMO. “Placing him on ECMO could continue to give us the time to treat his heart without risking brain injury,” he says.

How ECMO gives the heart and lungs a break

During the ECMO process, blood from the body is pumped outside of the body and into a heart-lung machine, says Dr. Mihir Barvalia, an interventional cardiologist affiliated with Sharp Grossmont Hospital. The machine removes carbon dioxide from the blood and sends oxygen-filled blood back to tissues in the body.

“Through tubes, blood flows from the right side of the heart to the membrane oxygenator in the heart-lung machine and then is rewarmed and sent back to the body,” says Dr. Barvalia. “This method allows the blood to ‘bypass’ the heart and lungs, allowing these organs to rest and heal.”

The ECMO process is part of Sharp HealthCare’s Extracorporeal Cardiopulmonary Resuscitation (ECPR) Pilot Program. Sharp Grossmont Hospital, along with Sharp Memorial Hospital, are two of three hospitals in the San Diego County program designated as ECPR receiving centers trialing the use of ECMO for patients experiencing out-of-hospital cardiac arrest.

“Before ECPR, we relied on traditional CPR — that is, using manual chest compressions and ventilation of lungs — to help patients who present with cardiac arrest recover brain function,” says Dr. Barvalia. “However, this alone has not made any significant impact on survival or neurological recovery, especially in patients with heart attack. ECPR allows for rapid circulatory support and was a perfect fit for patients like Mr. Martinez.”

However, being hooked to an ECMO heart-lung machine can look intimidating. Even the movies, Cassandra says, didn’t prepare her for what she saw as her father was treated.

“The movies don’t capture the tubes and wires coming out from his body and the dried blood under his nails,” she says. “But throughout the time my dad was on ECMO, his care team always kept communicating with me and my family, even answering our questions, no matter how redundant. If it wasn’t for them, the entire experience would have been too much to handle.”

Dr. Barvalia, Cassandra notes, was especially kind, explaining every step of the procedure and Charles’ response. “He treated me like a person, even in that stressful time,” she says.

The slow, steady road to recovery

After doctors determined that his heart and lungs had recovered, Charles was taken off the heart-lung machine. In total, he was on ECMO for five days. He is now conscious, able to speak again, and is on the slow, but steady, road toward recovery.

“Mr. Martinez’s story is indeed that of a miracle made up of all the hard work, timing and events that came together for him,” says Stirk, the ECMO coordinator. “Had we not had this ECPR program, it is likely he would not have survived.”

According to Dr. Kasto, adding ECMO to a patient receiving CPR in the emergency department is above the standard of care. It’s also something that only a few hospitals have the ability and resources to provide.

“We are fortunate to be a hospital that offers ECPR,” Dr. Kasto says. “Mr. Martinez’s case is one of pure joy to the emergency department team that helped save his life. This would not be possible without everyone doing their part.”

A future filled with gratitude

As for Charles, he is grateful for his extraordinary care. He believes people don’t realize what Sharp Grossmont has to offer the community.

“Everyone all working together and taking the extra steps to help me and my family and show us love made me feel so good,” he says. “I really appreciate that.”

To prevent future cardiovascular issues, Charles plans to work with cardiac rehabilitation specialists and follow a tailored exercise program. He’ll also attend follow-up appointments with Dr. Barvalia to manage his coronary artery disease.

“I miss my dog,” Charles says with a smile. “And I’m really just looking forward to moving on my own again, relaxing and being back home with my family.”

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