Saving lives is above all

Eric Tocco was playing racquetball last fall when he suffered a heart attack — yet the 43-year-old had no history of heart disease. An automated external defibrillator was used, but Eric’s heart didn’t immediately recover. Paramedics transported him to nearby UPMC St. Margaret Hospital, where CPR was performed for a full 30 minutes before he finally regained a pulse.

 Once stabilized, Eric was transported to UPMC Presbyterian Hospital, where he spent more than a week in a coma and on life support. Cardiac arrest is brutal, as the risk of death is 10 times higher than physical trauma and three times higher than stroke. But Eric’s chances for recovery were significantly improved, thanks to UPMC Presbyterian’s Post Cardiac Arrest Service (PCAS), a coordinated care program for all patients who’ve undergone CPR.

 PCAS is used from the earliest moments of a patient’s treatment through their discharge from the hospital and subsequent rehabilitation. “This was an effort we began in the last decade to improve the quality of care we provide to cardiac-arrest patients,” says Dr. Clifton Callaway, one of the program’s co-creators. The multidisciplinary program involves cardiologists and neurologists, as well as critical-care, emergency-medicine and rehabilitation specialists. “We haven’t invented new technology or new drugs,” Dr. Callaway says. “It’s taking critical pieces of care and sticking them together in a coordinated fashion.” At UPMC Presbyterian, Eric initially underwent therapeutic hypothermia, which lowers the body temperature to 92 degrees Fahrenheit (thus preventing further brain damage). “The most common cause of death for cardiac-arrest patients who’ve undergone CPR is brain injury [due to lack of oxygenated blood],” explains Dr. Callaway. “About two-thirds of those who survive CPR and make it to an intensive-care unit have brain damage so severe that they don’t survive.” Before Eric awoke from his coma, the extent of his brain damage was not known.

 Over the next several days, Eric received the care that PCAS is designed to provide. Intensive-care doctors maintained his blood pressure and electrolytes (minerals in body fluids), and his ventilator was managed to promote brain blood flow. Eric’s brain had swelled, so doctors gave him fluids and positioned him strategically in his bed to treat the swelling. And when he experienced myoclonic seizures, neurologists were able to treat him instantly and aggressively. “Traditionally, patients simply didn’t survive myoclonic seizures after cardiac arrest,” Dr. Callaway says, “and now, remarkably, we’re seeing them discharged from the hospital.” Meanwhile, though Eric was still comatose, cardiologists provided timely cardiac catheterization to open the blockage causing his heart attack.. 

On day no. 9 in the hospital, Eric awoke from his coma. “The first person I saw was my daughter,” he recalls. “I kept trying to say, ‘I love you’. My mouth was moving, but nothing [came out]. The most important thing is that I’m here. I’m alive and kicking.” Because of the PCAS program, survival rates for patients like him have risen from about 30 percent to above 40 percent, says Dr. Callaway. “Eric had a number of features that traditionally — and by that I mean seven or eight years ago — were fatal,” he says. Today, Eric — one of over 200 patients treated by PCAS at UPMC Presbyterian last year — continues his rehab for slight memory problems and a leg injury related to his CPR chest compressions. “Even though I have a little way to go, I’m willing to do what it takes. I’m grateful for where I am,” he says. “I know it’s a bit of a miracle.”