APOLLO HOSPITALS CHENNAI A PIONEER IN REVIVING OUT OF HOSPITAL CARDIAC ARREST PATIENTS
- Almost 8 lakh people die off sudden cardiac arrest every year in India with over 80% of these emergencies occur outside a hospital setting.
Chennai 16th July 2019: On average, a victim
begins to suffer irreversible brain damage 4 minutes after the cardiac arrest
takes place if no CPR. Cardiac arrest is sudden stopping of heart function,
resulting in loss of effective circulation (absence of heart beat with lack of
blood supply and oxygen eventually leading to death). It includes a TRIAD of
unconsciousness/unresponsiveness; loss of normal breathing; loss of pulse and
blood pressure. The unpredictable and time-sensitive nature of Out of Hospital
Cardiac Arrest (OOHCA) makes it a unique medical emergency.
The most common cause of OOHCA is cardiac
disease, particularly coronary artery disease (CAD)
and other structural heart diseases, such as cardiomyopathy. Only 25% to 30% of
patients with OOHCA initially achieve return of
spontaneous circulation (ROSC) and are admitted to the
hospital. The outcome of these patients even after admission in hospital
remains low due to the damage created to the other organs by the lack of blood
supply, at the time of arrest.
Apollo Hospitals Chennai is a pioneer in
reviving patients who are brought to the Emergency Room with an OOHCA
emergency. The specialists from Apollo Hospitals under the guidance of Dr. Refai Showkathali, Senior
Interventional Cardiologist, Apollo Hospitals Chennai recently gave a
new-lease of life two patients who suffered an Out of Hospital Cardiac Arrest.
78 year old
man
who developed chest pain collapsed on the way to the hospital, on arrival to
Apollo Hospitals Emergency Room he was immediately connected to a ventilator
and underwent CPR and his hear beat revived. He underwent a special balloon
inserted to support the heart pumping. Angiogram showed 100% block in his heart
blood vessel and therefore emergency angioplasty was performed to open the
blocked vessel under the guidance of Dr.
RefaiShowkathali. His blockage also was filled with chalk material
(“calcification” in medical terms) and has to have special drilling technique
called rotablation to help pass the stent. The patient’s heart pumping functions
improved slowly over the next few days and was discharged from hospital.
Another gentleman, in his 60’s woke up one morning in June 2018 at home with some
giddiness and he went to a clinic to see a doctor, and collapsed in the
reception. He underwent resuscitation there immediately and had an ECG done
which did not show any major issue. He was shifted immediately to Apollo
hospital, he was semiconscious and his BP was extremely low. Therefore his
lungs were secured with intubation and he was put on a ventilator. An urgent
echocardiogram (heart scan) showed large collection of fluid around the heart
and that is putting a lot of pressure on heart(In medical terms, this is called
as cardiac tamponade) preventing the heart to pump normally. He was immediately
shifted to the cardiac catheter lab to remove the fluid. The procedure was
carried by Dr Refai Showkathali, and
around 250 ml of fluid was removed from around the heart. Immediately after
removing the fluid, the blood pressure started to improve and the heart started
to function normally. He was then taken to cardiac intensive care unit for 24
hours and moved to room. The fluid collection was found to be due to his
underlying kidney problem. He was discharged from the hospital in few days and
he is undergoing regular treatment for his kidney problem.
Discussing the cases Dr Refai Showkathali, Senior Interventional Cardiologist, Apollo
Hospitals Chennai, said, “These 2 cases highlight the importance of timely cardiac
intervention for patients who had OOHCA by a team of experts, who are available
in the hospital 24/7 in hospitals like Apollo Hospital. In these patients,
every minute of delay in intervention can make the outcome worse, as the blood
supply to all other organs are provided by the heart. Not only the timely
cardiac intervention, but also the holistic care by team of doctors such as
Emergency physicians, Intensive care doctors and the nursing care have a huge
impact to get successful outcome.
Real progress in OOHCA outcomes may only be
achieved by a team of dedicated emergency specialists and Interventional
Cardiologist who can lead the management of these patients with the support of
other medical team. This has shown remarkable improvement in the survival of
these patients in various studies. Timely intervention increases the chances of
survival when the patient reaches to specialised healthcare units. We have many
examples of these patients who survived OOHCA and walked out of the hospital.