Collaboration, Speed, Technology and Expertise Saves Patients in Community Hospitals
A community hospital can frequently provide all the services patients need. However, in complex cases, patients’ lives depend on the interconnected services that systems like MedStar Heart & Vascular Institute can deliver: collaboration, speed, expertise and the latest technology.
Temple Hills, Maryland, resident William Green is a case in point.
- On Feb. 8, Mr. Green, 72, a retired postal worker, arrives by ambulance at MedStar Southern Maryland Hospital Center’s Emergency Department (ED) in respiratory distress.
- An EKG shows diffuse ST changes, including ST elevation in the lead AVR. Interventional Cardiologist Mun Hong, MD, has Mr. Green intubated before taking him to the Cath Lab.
- Once there, Mr. Green goes into cardiac arrest with electromechanical dissociation. A Code Blue is called, and after 10 minutes of CPR, a pulse is established.
- After placing a guiding catheter in the left main coronary artery, Dr. Hong sees that this artery had become completely blocked. He immediately employs life-saving balloon angioplasty to open it.
- Although Mr. Green would have benefited from emergency coronary artery bypass surgery, time is of the essence. Dr. Hong stabilizes Mr. Green with an intra-aortic balloon pump and secures coronary blood flow with a left main stent.
- Mr. Green remains hemodynamically unstable and needs the additional advanced mechanical circulatory support of an “extracorporeal membrane oxygenation” (ECMO) machine, which more completely does the work of the heart and lungs. ECMO is available at MedStar Washington Hospital Center, 20 miles away. Both hospitals are part of MedStar Heart & Vascular Institute (MHVI).
- Using this invaluable network, Dr. Hong calls his colleague, cardiac surgeon Christian Shults, MD, at the Hospital Center and sends images through the ImageShare website.
- Almost simultaneously, Mr. Green is transported via helicopter to the Hospital Center via MedSTAR Transport (“the flying ICU”).
- Bypassing the ED, the transporters deliver Mr. Green directly to the Cardiovascular ICU, where the rooms are large enough to accommodate the bedside insertion of ECMO. This eliminates the need to go into the operating room.
- Dr. Shults places Mr. Green on peripheral ECMO at the bedside, giving his heart the opportunity to rest and recover.
- Over the ensuing week, Mr. Green is gradually weaned off ECMO support and discharged to recover at home.
- Because the stent had been placed emergently and its critical location in the left main coronary artery, a followup angiogram is performed that shows 50 percent stenosis of the stent, as well as another coronary lesion, requiring bypass.
- On May 19, Dr. Shults performs a coronary artery bypass grafting (CABG).
- Today, Mr. Green is doing well.
MedStar Washington Hospital Center receives several patients a day like Mr. Green who need the complex technology and expertise available at the Nancy and Harold Zirkin Heart & Vascular Hospital. They are transferred there from MedStar hospitals, as well as from other hospitals throughout the mid-Atlantic.
Dr. Shults says the ability of MHVI to treat patients like Mr. Green is based on three essential elements:
- The expertise of the staff—those at the Hospital Center as well as those in the community hospitals—to know which patients can benefit from MHVI’s resources
- Cardiac ImageShare, which rapidly transfers studies via our secure DICOM website using PACS connections, so specialists can review them as the patient is in transport
- MedSTAR Transport, which can reach doctors immediately and transport patients by helicopter or ambulance quickly.