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At the age of seven, John Alexis Martinez Abarca, a seemingly healthy, soccer-playing youth from south central Pennsylvania experienced not one, but two cardiac arrests. Although revived by life-support measures, he very nearly died from organ shutdown due to heart failure.
It was a nightmare to be sure, but one with a remarkable ending. Through the skilled use of the latest techniques in heart failure management and mechanical circulatory support systems, the Heart Failure and Recovery team of the Heart Institute at Children’s Hospital of Pittsburgh of UPMC restored the boy’s heart to near-normal function within a week.
According to John’s mother, Telma, in April 2013 her son awoke with symptoms that suggested he might have caught a stomach bug. He was throwing up and had a fever. A trip to his pediatrician ensued, but in 72 hours, with John’s condition worsening, she took him to a local emergency room. He was diagnosed with flu and pneumonia and sent home.
John returned to school after a week, but the school nurse phoned Mrs. Abarca to say he was crying and experiencing pain in his neck. There were concerns he might also be dehydrated from being sick. His parents again took him to the emergency room, where blood tests showed elevated CPK (creatine phosphokinase) enzyme levels, which can suggest injury to the heart, brain, or muscle tissue. He was sent to a regional medical center for further evaluation, and magnetic resonance imaging (MRI). He was kept for a month at the hospital and given bed rest and fluids for treatment of the elevated enzymes.
When doctors noted he was improving, John was discharged to a rehabilitation center to help regain his strength. While there, he started having seizures, and doctors noted that his pulse was slowing and weak. He was transferred back to the regional medical center, where he soon suffered a cardiac arrest requiring seven minutes of CPR. Placed in the cardiac care unit, he was diagnosed as having hypothyroidism and arrhythmia. Doctors considered a pacemaker for the arrhythmia but determined, based on his weakening heart, that he should be transferred to a Philadelphia hospital for a heart transplant. While waiting for an ambulance for the 100-mile trip to Philadelphia, John suddenly experienced his second cardiac arrest.
CPR compressions by two physicians restored his heartbeat, but John’s heart was so weak that the medical team put him on ECMO to oxygenate the blood and maintain circulation. Mr. and Mrs. Martinez were cautioned that their son could possibly lose his leg as a result of the ECMO cannula (tube) insertion through the femoral vein in his right leg. John’s heart was not improving, and the medical center could do little more than sustain him on ECMO for a few days. At that stage, the center’s physicians reached out to the Heart Institute at Children’s Hospital of Pittsburgh of UPMC, with its specialized ECMO/VAD Transport Service and established Heart Failure and Recovery Program.
As Children’s Hospital’s Peter Wearden, MD, PhD, explained, “Many are hesitant to transport people on ECMO within their own hospital because there’s risk of things not going well, much less transporting them over long distances by ambulance, airplane, or helicopter. One of the things we offer that many hospitals don’t or can’t – including those that do pediatric transplant – is a really accomplished transport team. No matter what device the child is on, we can retrieve the patient and bring them to Pittsburgh.”
In less than four hours, Children’s Transport Team transferred John from his bed in central Pennsylvania to Children’s Cardiac Intensive Care Unit – a 175-mile trip, via helicopter. Children’s Heart Failure and Recovery team went to work. “We have a different level of expertise in how we deal with these cases,” Dr. Wearden said. “The original ECMO circuit was not working optimally for John. When we took him into the operating room, his kidneys and his liver were failing as well, so we didn’t feel that he’d be a good candidate for a ventricular assist device (VAD).”
VADs support circulation, but do not provide oxygenation like an ECMO device, Dr. Wearden explained. He said that his team anticipated John would require a heart transplant, depending on the extent of his heart damage.
“So we kept him on ECMO, but did things differently, removing the cannula from his leg and opening his chest to put cannulas in places that would better decompress the heart. Although his heart was continuously fibrillating, during the surgery we were able to get it back into rhythm, which was crucial.”
About four liters of fluid that had been constricting his heart was also drained during the procedure. With the ECMO system performance optimized for John’s body, he improved rapidly in the first few days, and with his heart failure reversing, the potential step to a VAD was considered unnecessary.
“After a week, his heart looked almost back to normal and we were able to take him off ECMO,” Wearden said. Children’s doctors are now addressing other medical issues, such as his hypothyroidism.
As for how John’s heart was able to recover so quickly, Dr. Wearden compared the heart to the healing of any other injured body part.
“If the heart has to do work, it’s never going to rest and recover. If we break an arm, we can rest it, and the limb mends,” Dr. Wearden explained. “Unfortunately, our hearts can’t rest because they need to pump continuously. However, machines can provide the relief that is needed, and then the body can heal.”
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Pittsburgh, PA 15224
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