In what seems like a sequence of events straight from a movie, a 37-year-old patient from Gujarat, was airlifted to Chennai, went into cardiac arrest while waiting for a heart transplant, was given cardiopulmonary resuscitation for 45 minutes and when still unresponsive, was given ECPR (extracorporeal CPR), was unconscious for 10 days, woke up and then received a new heart sent from Hyderabad.
Jaisukhabi Thakur, a stationery shop owner from Gujarat was brought to Fortis Malar Hospital in January, with dilated cardiomyopathy. He required a heart transplant and was waitlisted. “But on January 13, he suffered a sudden cardiac arrest,” K.G. Suresh Rao, head of cardiac anaesthesia at the hospital, told press persons on Tuesday.
Director of cardiac sciences K.R. Balakrishnan said the patient had no pulse and no heartbeat. Cardiopulmonary resuscitation was given for 45 minutes and when this did not work, he was rushed to the ICU where he repeatedly had attacks and was then given ECPR – hooked to a device in which blood is taken out of the body, oxygenated and then goes back into the body – maintaining circulation. This ensures the brain continues to work. The device is the extracorporeal membrane oxygenator or ECMO. “It was only about half an hour after this that his heart started beating,” he said.
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Mr. Thakur remained unconscious, only waking up on the 10{+t}{+h}day. Two days later, Dr. Rao said, an artificial heart pump was inserted in him as ECMO could be not continued indefinitely. Four days after this, a midnight message to the hospital said a heart was available in Hyderabad. “Since it was such short notice, we didn’t have time to send a team to harvest it. The donor hospital agreed to harvest it, but could not send anyone with it to Chennai. So, the heart arrived in an air ambulance to Chennai,” he said.
Nearly three months on, Mr. Thakur is walking, though with a slight limp, and is planning to go back home.
The use of the ECPR for sudden cardiac arrests could help saving patients, said Dr.. Balakrishnan. “Sudden cardiac arrests are one of the great unsolved problems of our time. Out-of-hospital survival is poor in India and even in a hospital setting, survival is not more than 15 per cent. Even if the heart survives, the brain often dies. ECPR maintains brain function, allowing doctors to decide on treatment and letting patients wait for transplants,” he said.
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This technology, said Sanjiv Agarwal, consultant cardiologist, can help patients who develop cardiac arrests with acute heart attacks.
In Mr. Thakur’s case, said Dr. Balakrishnan, when he arrested, he was, for all practical purposes, dead. But the use of this technology brought him back, and if used effectively, could save hundreds of lives.
Ideally, the doctors said, patients should be put on ECMO within 15 minutes of arresting if the heart has not recovered – to avoid any chance of brain damage. Mr. Thakur, doctors suspect, has suffered slight neurological damage but they are hopeful he will recover.
For Manisha, the patient’s wife, what happened was a miracle.
“People in my village told me that he would not recover and to bring him back. And now, he is alive and doing well,” she said, crying.