World-renowned NHS doctors are using ‘James Bond medicine’ and cutting-edge technology to save the lives of people whose hearts collapse due to rare and often fatal heart disease.
Royal Brompton and Harefield NHS Trust in London has started sending teams of specialist medical staff to hospitals in England and Wales to pick up patients who would otherwise die.
People with cardiogenic shock (CGS) are brought to the Royal Brompton Hospital, one of Britain’s centers of excellence in cardiac medicine, in a last-ditch attempt to save them.
Patients receive intensive treatment only available in a few hospitals, including extracorporeal membrane oxygenation (ECMO), in which blood is drawn from their body, receives supplemental oxygen and is then delivered to try to help them. breathe again on their own.
As part of the trust’s ‘shock program’, its doctors, surgeons and intensive care experts also discuss and give advice on how to treat people with CGS, a condition for which hospitals across the UK have. asked for urgent help. The trust’s work increases survival rates among the 10,000 people per year who end up in CGS, which until recently had a death rate of around 50%.
The disease is a life-threatening condition in which the patient’s heart suddenly cannot pump enough blood through the body, and left untreated can quickly lead to multiple organ failure and death.
Most cases occur as a side effect of a severe heart attack, which primarily affects older people. But it can also be caused – especially in young adults – by a clot on the lungs, a faulty heart valve, an abnormal heartbeat, childbirth, or an infection damaging the heart muscles.
âIt’s the extreme manifestation of heart failure and a byproduct of another medical emergency. It’s like having cardiac arrest, but in slow motion, âsaid Professor Susanna Price, a cardiology and intensive care consultant at Brompton, who runs the program.
Professor Martin Cowie, consultant cardiologist and head of the heart failure program, said: The NHS is making sure that patients who could benefit will be there, wherever they are.
âWe don’t care why your heart has failed. We just want to save you.
The trust set up the service – the first of its kind in the UK – after a 17-year-old girl with CGS in a remote part of Wales died in 2018 after hospital treating her misdiagnosed as having sepsis. âIt was extremely distressing because she had a potentially reversible illness. My colleagues and I realized that there was no national program to treat CGS, thought that “it was not enough” and decided to set up our shock program, “said Price.
As soon as another hospital alerts them of a case, the trust calls an emergency meeting of a virtual multidisciplinary team – even overnight – of an array of Brompton’s top specialists. They then guide the doctors on the best way to take care of the patient or send a blue light ambulance to pick them up. Treatment at the London hospital gives them a better chance of living, although not everyone survives.
The Brompton treats 700 patients a year who have suffered a major breakdown of their cardiac system, of which 60 to 70 ended up in CGS.
The ECMO machine – an 18-inch tall metal contraption – is vital to survival. About 20 to 30 patients per year continue this and are in a coma; it is the highest form of life support in the NHS, above that of a mechanical ventilator. The others are put on ventricular assistance. The tubes entering and exiting the machine are red with the blood drawn and returned.
âECMO is not a treatment as such. The ECMO machine saves us time. It supports the body as we correct the underlying cause, such as performing surgery to repair a heart valve, âPrice said. But, she added: “ECMO can be a very, very high-risk invasive thing to undertake, especially with older patients who have had a heart attack.”
The success of the shock program means doctors at hospitals across Europe now occasionally call Brompton for advice. The team even picked up a British national in CGS from Spain.
Nine to ten times a year, they also perform a cesarean section on a pregnant woman who is in CGS. So far, all of the mothers involved have survived.
The shock program increased the survival rates of patients treated with Brompton for CGS, from 51% in 2018 to 86% in 2020-2021.
Reflecting on this dramatically reduced mortality, Price said, âIt’s very gratifying to be able to bring people back to life. You have the patient there and we, as a team, are able to bring extraordinary expertise and negotiate a path to survival without which they would have died. “