Pilot program in Pittsburgh area boosts survival odds for cardiac arrest patients

Mary Fischer didn’t know she had heart problems until she collapsed one day in early June.

Fischer, 51, was in her home in Pittsburgh’s West End, slicing pepperoni in preparation for a pizza night with her boyfriend on June 11. While she was trying to plug in her pizza oven, she collapsed, suffering cardiac arrest — a life-threatening condition that causes the heart to stop pumping blood.

Luckily for Fischer, her boyfriend started CPR and called 911. Firefighters soon arrived to continue chest compressions until EMS came and took over.

They rushed her to Allegheny General Hospital, where doctors put her on an extracorporeal membrane oxygenation machine — or ECMO — that kept oxygen in her blood, even while her heart wasn’t working.

Doctors said it saved her life.

These days, Allegheny General Hospital is teaming up with Pittsburgh, Ross/West View and Shaler/Hampton EMS services to continue expanding use of the method.

Reducing a deadly toll

When people go into cardiac arrest outside of a health care setting, it’s almost always deadly, said Dr. Stephen Bailey, chair of Allegheny Health Network’s Cardiovascular Institute.

About 350,000 people experience out-of-hospital cardiac arrest each year, according to AHN, and only about 10% survive.

But increasing use of the oxygenation machines to help people who suffer cardiac arrest in the field is helping to improve their odds of survival, AHN doctors and EMS officials said Monday during a news conference at Allegheny General Hospital on the North Side.

In the last year, the health network used the protocol on seven patients who suffered from cardiac arrest outside of the hospital. Three of them — or 43% — survived.

The hospital system could not provide data for the pilot program’s first two years.

“Without ECPR, three of our patients in the past year would be dead,” said Dr. Tyler VanDyck, co-director of the AHN Cardiothoracic Surgical Unit ICU and medical director of the ECMO program. “They’re now at home spending cherished time with their loved ones.”

Data from the University of Minnesota Medical Center showed there’s a nearly a 100% chance of reviving patients with certain types of cardiac arrest if ECMO is administered in the first 30 minutes.

Pilot program

Allegheny General Hospital launched a pilot program with Pittsburgh, Ross/West View and Shaler/Hampton EMS in 2021.

Initially, patients could receive the specialized care only at limited times when the proper staff were working at the hospital. Since February, it’s been a 24/7 effort.

Hospital officials said they hope eventually to expand the initiative to other hospitals and other EMS units.

Before this new option, the standard protocol for a patient who was suffering cardiac arrest outside the hospital had been to use CPR, defibrillation and other measures on the scene.

If emergency crews could restore a pulse, they would take the patient to the hospital; if they couldn’t, the patient would be declared dead at the scene.

Pittsburgh EMS typically spend about 20 to 40 minutes resuscitating cardiac arrest patients on scene, Eliza Durham, a city public safety spokeswoman, said.

The new program encourages EMS to work on a patient on-site for about 10 minutes before transporting them to the hospital as quickly as possible to connect them with the lifesaving technology now available.

Some patients can be revived in those first 10 minutes, Pittsburgh Assistant EMS Chief Mark Pinchalk said.

The others, if eligible, can be moved into the special program.

First responders continue caring for the patient en route to the hospital, Pinchalk said, and they alert doctors in advance to ensure the oxygenation treatment is ready as soon as they arrive.

Once the patient arrives at the hospital, doctors perform a surgical procedure to insert tubes connected to the oxygenation machine through the femoral artery in the leg, VanDyck said.

The machine maintains blood pressure and oxygen levels, even when the heart isn’t working.

That buys doctors time to fix the heart problems that triggered cardiac arrest, VanDyck said.

“They’ll remain on this machine for as long as it takes to hopefully recover their heart,” he said.

Currently, Allegheny General Hospital has 10 of the machines.

Pittsburgh EMS has a similar partnership in place with UPMC Presbyterian Hospital, according to Pinchalk.

‘Fate and luck’

While the program seems promising for patients who qualify, not everyone will be eligible.

People need to be hooked up to the machine within an hour, so patients who are too far from Allegheny General Hospital or UPMC Presbyterian Hospital can’t access this type of care.

Patients who don’t have someone performing CPR on them right away also can’t access the treatment, and some patients who have other serious conditions may not be good candidates either.

Getting patients to the hospital within the tight time frame required for the treatment is tricky, especially if ambulances are fighting rush-hour traffic or traveling from farther points in the city, Pinchalk said.

“You have to thread that needle,” he said. “Some of this is just fate and luck.”

On average, it takes firefighters four to six minutes to respond to a 911 call. EMS crews are typically on scene within six to eight minutes, he said.

But to access the treatment and get the best results for patients, Pinchalk said, doctors are relying on bystanders to perform CPR in those crucial first minutes until help arrives.

Patients have to be fortunate enough to go into cardiac arrest around witnesses who can immediately jump into action and call for help.

Returning to normal life

Fischer said she’s grateful luck was on her side, and she’s thankful for the first responders and doctors who helped save her life.

Most people, she said, probably don’t realize how bleak the outcomes can be for people who suffer cardiac arrest outside of the hospital. And most people don’t know about the innovative new treatments that are improving those prospects.

Fischer said she hopes to help raise awareness for people to get their hearts checked and learn about the lifesaving efforts underway at Allegheny General Hospital and elsewhere.

Fischer was on the oxygenation machine for about 24 hours. She spent about 12 days in the hospital, and she’s still going to physical therapy as she recovers.

“I’m trying to get back to my normal life,” she said. “I’m almost there.”