"Symphony" of Care Saves Patient After Heart Attack

After having a heart attack at home, John Carroll arrived at the UCSF Emergency Department with an estimated 13% chance of survival. His condition remained uncertain as his heart stopped two more times that night. But thanks to what his wife, Lorraine, described as a "symphony" of care by the cardiovascular specialists at UCSF, John eventually made a full recovery. "It wasn't his time to go," she says.

Working closely as a team, emergency doctors, interventional cardiologists, surgeons and other providers delivered timely cutting-edge treatments, including two mechanical support devices to assist John's heart in the early hours of his hospitalization. Those interventions saved his life, he and experts agree. "[My UCSF care team] kinda pulled a rabbit out of a hat," John says. "They were remarkable."

John, a 64-year-old retired police officer, had been living for five years with heart failure, a chronic condition in which the heart doesn't pump enough blood to meet the body's needs. His heart failure was likely caused by high blood pressure and coronary artery disease (CAD), a narrowing of the arteries that is the most common type of heart disease. CAD affects about 18.2 million Americans over the age of 20, according to the Centers for Disease Control and Prevention.

With regular checkups and medications, John had been doing well and enjoying his retirement. His heart failure was well managed, according to his cardiologist, Dr. Liviu Klein. "He was in good shape," Klein says. "His heart was a little bit stiff, but it was very well treated."

Then, one October evening in 2021, Lorraine sensed something was off. "He was outside, chatting away with neighbors, but he wasn't himself," she recalls. "I wasn't able to put my finger on it, but I knew he wasn't OK."

While Lorraine prepared dinner, John lay down. When he got up a short time later, he felt unwell and was drenched in sweat. Lorraine, a registered nurse who directs the UCSF Heart and Vascular Center, quickly clocked what was about to happen. The instant he went into cardiac arrest, she recognized it. "I started doing chest compressions with one hand and calling 911 with my other hand," she recalls.

Lorraine was able to resuscitate her husband, but she knew immediate medical attention was still needed. Within 15 minutes, John arrived at the emergency department via ambulance. He was admitted and transferred to the cardiac catheterization lab, UCSF's specialty center for minimally invasive heart treatments.

"He was not in good shape," says interventional cardiologist Dr. Krishan Soni, who quickly performed a coronary angiogram, an imaging technique for viewing the heart's blood vessels. The results showed his right coronary artery was 100% blocked. "After we took pictures of that, he went into cardiac arrest," Soni says.

Lorraine was waiting in the lobby for news when she heard "code blue, cath lab" over the loudspeaker. She knew it meant someone was having a cardiac arrest or another emergency.

"I looked at my daughter and said, 'Oh, my God, that's Daddy,'" she recalls. "I wanted to help but knew I couldn't."

To resuscitate John, Soni's team used CPR in combination with an automated external defibrillator, which delivers an electric shock to the heart. "He came back and was able to answer questions," Soni recalls. "It was still very tenuous."

Because his heart was so weak, the team decided that before trying to open his blocked artery, they needed to support it with a mechanical assist device called the Impella heart pump. The tiny device is temporarily implanted in the heart's left chamber to take over the job of pumping blood back into the body, allowing the heart to rest. With the pump in place, Soni's team began fixing the blocked artery with angioplasty (a minimally invasive method of opening up the artery) and a stent (a mesh tube that keeps the artery open). During the procedure, John had yet another cardiac arrest.

Although the pump was helping, John needed to be shocked again multiple times to get his heart into a regular rhythm. At that point, Soni's team intubated him to support his breathing, finally finishing the procedure and transferring him to the intensive care unit.

Overnight, John began showing signs of worsening cardiogenic shock, a life-threatening condition in which the heart isn't able to pump adequate blood and oxygen to the brain and other vital organs. It's often triggered by a severe heart attack, accompanying it in 10% of cases.

"When someone is in full-blown shock, everyone recognizes it, but it might be a point of no return," Klein says. Luckily, John's condition was caught early. The Impella pump is one treatment for cardiogenic shock. But John clearly needed more support.

That morning, he was connected to an extracorporeal membrane oxygenation (ECMO) machine, an advanced treatment to take the workload off John's heart and lungs by pumping his blood through an external artificial lung (which removes carbon dioxide, adds oxygen and then pumps the blood back into the body). ECMO is used for patients recovering from heart or lung failure as well as for patients in cardiogenic shock.

"The ECMO provides full cardiac support, so all the organs get full blood supply, and the Impella helps the left side of the heart," Klein says. "In many patients, we use them together. It's sort of somewhat unique to what we do at UCSF and contributes to our successful outcomes. Our survival in cardiogenic shock cases is significantly higher compared to other U.S. centers."

With the Impella and ECMO in place, John finally began to stabilize and then rapidly improve. He was discharged from the hospital 17 days after his heart attack and received follow-up treatment at the UCSF Cardiac Rehabilitation and Wellness Center to support his ongoing recovery.

"John himself, he's a fighter. He went through a lot – he persevered and fought," Soni says. "I think that his grit, resilience and toughness were a big piece of his recovery."

The Carrolls praise the collaboration among specialists and timing of the various treatments for John's full return to health. "It was like a symphony: Everyone knew just what to do to save his life," Lorraine says.

That kind of timely intervention is critical to a patient's care, Klein agrees. "Being able to work together and intervene early, that's what changes outcomes."

On a trip to Turks and Caicos just months after his discharge, the only visible evidence of John's recent experience was a patch of untanned skin where paddles had shocked his heart back into rhythm. He had returned to his favorite pastimes, such as boating and swimming along the archipelago of coral islands in the sparkling Atlantic Ocean.

"I'm happy as a clam," John says. "I'm alive! I'm very grateful."