By Kristen Jordan Shamus Detroit Free Press
WWR Article Summary (tl;dr)Back in March, Michelle Rachuk simply thought she had a cold and felt rundown. However, the state of her health was much more serious. Fortunately, the local hospital she went to had just received a special piece of equipment which may have ultimately saved her life.
Detroit Free Press
Serendipity brought Michelle Rachuk to Henry Ford Macomb Hospital near Detroit in early March. The trip undoubtedly saved her life.
Weeks earlier, the hospital had received a donation of a new machine that works like an artificial heart and lung. Called ECMO (extracorporeal membrane oxygenation), it oxygenates the blood and pumps it through the body of a person whose organs are failing.
The machine essentially takes over for the heart and lungs, and can keep someone in distress alive, giving a patient critical time to heal.
ECMO technology is expensive and not many hospitals have the device and properly trained medical staff who can use it. In Macomb County, Michigan, Henry Ford Macomb Hospital is the only one.
And it just so happens that Rachuk walked into its doors March 9, not realizing how badly she would need ECMO or that she would become the hospital's first patient to use it.
Earlier that weekend, Rachuk, 49, was visiting her parents, Michael and Joanne Rachuk. She'd packed a bag and brought her dog, Pepino, with her so she could sleep over and take her mom to the hairdresser.
Rachuk, who works as a computer programmer, thought she had a cold and felt rundown.
"I wasn't even really coughing or anything like that," Rachuk said. "I was a little stuffy. There was no chest pain. I don't think I was short of breath, but my mom thought I was a little short of breath."
Their hairdresser agreed, so Rachuk went to a nearby urgent care center to get checked out. There, she learned she had Influenza B and pneumonia, but also that her blood sugar levels were alarmingly high. The urgent care doctor detected a heart anomaly, too, and told her to quickly get to an emergency room.
Rachuk went to the nearest one, Henry Ford Macomb in Clinton Township, which is where interventional cardiologist Dr. Majid M. Al-Zagoum assessed how dire her condition really was.
"She was in acute heart failure," he said. "Her shortness of breath and her symptoms were not from the flu. They were because the heart was not working. The normal functioning heart pumps 50% out. Hers was only pumping 10% out. And we had evidence of a blockage from the cardiac markers, which were elevated. So we know there was a heart attack that started this."
Women, have to be especially cautious when it comes to heart health because they often don't have what are considered classic heart attack symptoms such as chest pain and heaviness, said Al-Zagoum.
"Many times, their presentation is atypical," he said, "and they need to take into account that they don't always get chest pain when they have heart disease. They can have some other symptoms that they may ignore."
Those symptoms can present as exhaustion; chest pressure, squeezing, fullness or pain; pain in one or both arms, the back, neck, jaw or stomach; shortness of breath without chest discomfort; nausea; lightheartedness, and fainting, according to the American Heart Association.
"We want to push that for women, especially over 40 years old, go see a doctor. Get checked out just to be safe," Al-Zagoum said. "At least get an EKG to make sure everything is OK."
It wasn't until the morning of March 11 that Rachuk was stable enough for a cardiac catheterization procedure that would allow Al-Zagoum to place a stent in one of her two blocked arteries.
"She had one artery that was completely blocked and the other artery was 99% blocked," he said. But when blood started to flow again in the artery with the 99% blockage, Rachuk's heart stopped beating.
Al-Zagoum began CPR, and inserted an Impella device, which can help the heart pump blood. It didn't work. His medical team continued chest compressions on Rachuk for more than an hour, trying, but failing, to restart her heart.
Rachuk was dying, but Al-Zagoum wasn't willing to give up. He called cardiothoracic surgeon Dr. Raed Alnajjar.
"She was so blue, I was looking at someone who was almost not alive, you know?" Aljannar said. "At one point, I was like, OK, there's nothing we can do. I said, 'I think we've really gone above and beyond everything.' But then, I asked him this question, I still remember that, I said, 'How old is she?' "
When he learned that Rachuk was just 49, Alnajjar decided it was worth trying one last thing.
"Scientifically, she had a condition where Dr. Al-Zagoum opened the heart, and we had the blood going in, but there was what we call in medical terms a reperfusion injury, or heart stunning," he said. "The heart was stunned because the blood is coming back to the heart and the heart is kind of dysfunctional at this point. Sometimes it takes 24 to 48 hours to come back. That's what she needed at that point was to have support until her heart recovered."
Alnajjar had been trained to use ECMO and had worked with the equipment at a hospital in Kentucky. He knew just how powerful it could be.
"We'd just gotten it. And I knew we still had to train the nurses and we still had to train the assistants, but we had the machine. So I went back to my perfusionist, and I said, 'Do you guys know where the machine is?' "
It was pulled off a shelf, and Alnajjar told a team of medical professionals to follow him back to the room where Al-Zagoum was continuing CPR.
"Everybody was like what are we going to do?" he said. "And I said, 'We are going to put a patient on this machine right now.' " Five minutes later, oxygenated blood was flowing again in Rachuk's body.
"She was on the machine," he said, "but I thought, if you want to save someone, usually 30 minutes, maximum, of doing chest compressions" is all that is sustainable. "She was there for more than an hour. I really did not expect that she was going to come out of it."
Still, Alnajjar made arrangements to have Rachuk transported to Henry Ford Hospital in Detroit, which has been using ECMO since 2012 and was better equipped with medical staff specially trained in ECMO support.
The machine is portable, which allows it to be used when patients are moved by ambulance or helicopter between hospitals. "Her life is depending on this machine," Alnajjar said. "Her heart is completely connected to this machine. ... It is an intense process, and it's continuous monitoring for sure. ... Putting somebody on the machine, it's no big deal. It's easy. But taking care of those patients after is the challenge."
ECMO patients have a dedicated nurse, sometimes two, who watch them around the clock.
Alnajjar said it was the best news when he got a text message later that same evening from Rachuk's doctor at the Detroit hospital.
"He was telling me, 'Hey, your patient is moving,' and I was like wait a minute," he said, in utter disbelief. "She was alive!" Alnajjar checked in on her every day and was thrilled with her recovery.
Two days later, Rachuk was weaned from the ECMO machine. A day after that, she no longer needed a ventilator to help her breathe. Within two weeks, she was able to be moved back to Henry Ford Macomb Hospital for rehabilitation. And after a month, she was back at her parents' with Pepino by her side.
Last week, Rachuk got to meet the family who donated the life-saving ECMO machine to the hospital. Vikram and Ajay Bedi made the donation in honor of their father, the late Raj Bedi, who'd had a successful bypass surgery at the hospital in 2010.