"Symphony" of Care Saves Patient After Heart Attack

Written By Emily Udell

Published July 2022

在家里心脏病发作后，约翰·卡罗尔来到了 UCSF Emergency Department with an estimated 13% chance of survival. 那天晚上他的心脏又停了两次，他的情况仍然不确定. But thanks to what his wife, Lorraine, 被加州大学旧金山分校的心血管专家描述为护理的“交响乐”, John eventually made a full recovery. "It wasn't his time to go," she says.

Working closely as a team, emergency doctors, interventional cardiologists, 外科十大赌博平台排行榜和其他医护人员及时提供了尖端治疗, 包括两个机械支持装置，在约翰住院的最初几个小时帮助他的心脏. Those interventions saved his life, he and experts agree. 约翰说:“(我的UCSF护理团队)有点像从帽子里变出了一只兔子。. "They were remarkable."

约翰是一名64岁的退休警官，已经和她一起生活了5年 heart failure这是一种慢性疾病，心脏不能泵出足够的血液来满足身体的需要. 他的心力衰竭可能是由高血压和冠状动脉疾病(CAD)引起的。, 动脉狭窄是最常见的一种心脏病. CAD affects about 18.根据疾病控制和预防中心的数据，20岁以上的美国人有200万.

有了定期的体检和药物治疗，约翰的身体一直很好，享受着他的退休生活. 据他的心脏病专家说，他的心力衰竭得到了很好的控制， Dr. Liviu Klein. "He was in good shape," Klein says. “他的心脏有点僵硬，但治疗得很好."

然后，2021年10月的一个晚上，洛林感觉到有些不对劲. “他在外面，和邻居聊天，但他不是他自己，”她回忆说. “我说不清是怎么回事，但我知道他不太好."

While Lorraine prepared dinner, John lay down. 过了一会儿，当他起床时，他感到不舒服，浑身是汗. 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. “我开始用一只手做胸外按压，另一只手打911，”她回忆说.

Lorraine was able to resuscitate her husband, but she knew immediate medical attention was still needed. 不到15分钟，约翰就被救护车送到了急诊室. 他被送进了心导管实验室, UCSF的微创心脏治疗专业中心.

能够一起工作，及早干预，这就是改变结果的原因.

"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. “在我们拍下照片后，他的心脏骤停了，”索尼说.

洛林正在大厅等消息，突然听到扩音器里传来“蓝色警报，导管室”. 她知道这意味着有人心脏骤停或其他紧急情况.

“我看着女儿说，‘哦，天哪，那是爸爸，’”她回忆道. "I wanted to help but knew I couldn't."

To resuscitate John, 索尼的团队将心肺复苏术与自动体外除颤器结合使用, 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, 他们需要一个叫做Impella心脏泵的机械辅助装置来支持它. 这个微小的装置被暂时植入心脏左腔，以接管将血液泵回体内的工作, allowing the heart to rest. With the pump in place, Soni的团队开始用血管成形术(一种打开动脉的微创方法)和支架(一种保持动脉畅通的网状管)固定阻塞的动脉。. During the procedure, John had yet another cardiac arrest.

Although the pump was helping, 约翰需要多次电击才能使他的心脏恢复正常的节奏. At that point, Soni's team intubated him to support his breathing, 最后完成手术，把他转到重症监护室.

Overnight, John began showing signs of worsening cardiogenic shock, 心脏不能向大脑和其他重要器官输送足够的血液和氧气，从而危及生命. 它通常由严重的心脏病发作引发，10%的病例伴随着心脏病发作.

"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, 他被连接到体外膜氧合(ECMO)机, 这是一种先进的治疗方法，通过将血液泵入外部人工肺(可以去除二氧化碳)，为约翰的心脏和肺部减轻负担, adds oxygen and then pumps the blood back into the body). ECMO用于心脏或肺功能衰竭恢复期患者以及心源性休克患者.

"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. 这是我们在加州大学旧金山分校所做的独特的事情，也是我们成功的原因之一. 我们在心源性休克病例中的生存率明显高于其他美国.S. centers."

随着Impella和ECMO的就位，John终于开始稳定下来，然后迅速好转. 他在心脏病发作17天后出院，并在加州大学旧金山分校接受了后续治疗 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. “我认为他的勇气、韧性和韧性是他恢复的重要因素."

卡罗尔夫妇赞扬了专家们之间的合作，以及约翰完全恢复健康的各种治疗的时机. “这就像一首交响乐:每个人都知道该怎么做才能挽救他的生命，”洛林说.

克莱因同意，这种及时的干预对病人的护理至关重要. “能够共同努力，及早干预，这就是改变结果的原因."

On a trip to Turks and Caicos just months after his discharge, 约翰最近经历的唯一可见证据是一块未晒黑的皮肤，那里的电击使他的心脏恢复了节奏. He had returned to his favorite pastimes, 比如沿着波光粼粼的大西洋上的珊瑚岛群岛划船和游泳.

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