County commissioner survives five cardiac arrests
Surviving a cardiac arrest once is remarkable; for Hilario "Larry" Garcia to overcome five is nothing short of a miracle.
It is fortunate to survive a cardiac arrest. It is a miracle to survive five of them. Hilario (Larry) Garcia considers himself a people person. Born and raised in McMullen County, 80 miles outside of the San Antonio City limits, Larry has devoted nearly two decades of his life to the McMullen County school district as Director of Maintenance and Transportation. He has also dedicated the last eight years publicly serving as Precinct 1 County Commissioner for McMullen County.
Late April, Larry was treated at Methodist Hospital | Metropolitan for an abscess. Due to an infection, his wound was carefully scanned throughout the healing process. When his care team performed a scan on the area, they discovered a small tumor developing on his left kidney. A biopsy confirmed a malignant tumor. Larry had an ablation on May 9, a minimally invasive technique commonly used in the treatment of tumors of the liver, kidney, bone, and lung.
Larry was scheduled to discharge from the hospital on May 11 and remembers waiting in his room for his son, Chuck Garcia, to arrive so that they could head home. Suddenly, Larry’s breathing became challenging and he began feeling dizzy. He was given oxygen, but within seconds, Larry went into cardiac arrest. His care team immediately began resuscitative efforts. Over an hour and half, Larry went into cardiopulmonary arrest five times.
Larry had suffered a pulmonary embolism, a blood clot that wedges into an artery in the lungs. These blood clots most commonly come from the deep veins of the legs, and in many cases, multiple clots are involved. The portions of lung served by each blocked artery are restricted of blood, making it more difficult for the lungs to provide oxygen to the rest of the body. He was given tPA, a strong clot dissolving medicine to alleviate the clot, but Larry continued to get sicker.
Time is of the essence when treating someone experiencing a pulmonary embolism (PE). In an effort to increase response times and reduce mortality, Methodist Hospital established a pulmonary embolism response team (PERT) to target and treat high-risk massive PE by effectively engaging multiple specialists to determine the best course of treatment and to coordinate rapid response care for patients with life-threatening conditions. Fortunately for Larry, this level of expert response saved his life.
His physician assessed his condition and contacted the Methodist Hospital PERT. If Larry could remain stable during the transfer to Methodist Hospital, he would stand a chance of living. Larry arrived to Methodist Hospital and PERT critical care specialists determined ECMO was his only chance at survival as his heart was unable to function on its own.
“My father’s mortality rate was 100% if he wasn’t put on ECMO,” Chuck recalled. “It was the only chance he had at survival.”
It was critical Larry showed positive neurological function to be placed on ECMO. “After someone has cardiac arrest, we don’t know how their brain will recover,” commented Pavan Thangudu, MD, Intensivist at Methodist Hospital. “The ability to follow requests is a great sign of brain function, and he was able to hold up fingers and count. He was showing promising progress.”
Larry was placed on veno-arterial extracorporeal membrane oxygenation (V-A ECMO), a form of cardiopulmonary life-support where blood is drained from the vascular system, circulated outside the body by a mechanical pump, and then reinfused into the circulation. This is done by inserting a catheter in the femoral vein on the right side of the groin, which removes deoxygenated blood from the body. A second catheter is placed in the femoral artery on the left side of the groin, which returns oxygenated blood from the ECMO circuit to the body.
“He was on massive life support and barely able to maintain normal blood pressure,” stated Thangudu. “He had significant clots in his lungs causing the right ventricle of his heart to fail. ECMO was able to relieve the pressure on his heart, ultimately sustaining his cardiac function.”
Surviving a cardiac arrest is fortunate. Surviving five of them is rare. Within 24 hours, Larry was off of his ventilator and all life support medications. Within 48 hours he was removed from ECMO.
“Traditionally, these types of patients are too sick to treat,” commented Thangudu. Larry’s survival highlights the benefits of early V-A ECMO for patients experiencing cardiopulmonary arrest and demonstrates the importance of established rapid response teams. Because PERT had been activated at Methodist Hospital, Larry is still with us today.
“Larry’s story is a reflection of what we are capable of achieving,” commented Thangudu. “This wasn’t someone we were expecting to survive, but the ideal medicine and expertise were in place to ensure a positive outcome for this patient.
Methodist Hospital reaches 1 year PERT anniversary
The Methodist Hospital PERT program has experienced great success within its first year of activation. PERT (pulmonary embolism response team) is a multidisciplinary team of physicians dedicated to providing the best available treatments for patients experiencing life-threatening pulmonary embolism.
Pulmonary embolism (PE) is a condition in which one or more arteries in the lungs suddenly become blocked by a blood clot, often leaving the patient to experience shortness of breath, sharp chest pain, and cough. This condition is a major cause of morbidity and mortality and presents with significant diagnostic and treatment challenges. While therapies for PE are available, the outcomes for high-risk patients who present with massive or high‐risk embolism are dismal. Time is of the essence when sudden medical issues present themselves, and it is vital to the patient’s outcome to seek the care of physicians trained to respond immediately.
Methodist Hospital executed a PERT team as an effort to effectively engage multiple specialists to determine the best course of treatment and to coordinate rapid response care for patients with a sub-massive and massive PE. Caring for patients with a pulmonary embolism may involve cardiac surgery and interventional cardiology, pulmonary critical care, echocardiography, radiology, vascular medicine as well as multiple of other specialties.
Clinical experts at Methodist Hospital recognized a proliferating population of patients suffering from PE and identified opportune areas to increase response times while decreasing mortality. While many institutions have implemented PERT programs, Methodist Hospital has the only PERT program in the South Texas region to target and treat high-risk massive PE using veno-arterial extracorporeal membrane oxygenation, V-A ECMO, which supports heart and lung function during major distress to the body.
To date, the PERT has successfully treated over 175 patients with pulmonary embolism throughout the region, 15 of which have been massive. This nationally ranks the Methodist Hospital program among the top academic PERT teams in the nation and positions the program to be internationally acclaimed. The PERT is led by the pulmonary and critical care services under the expertise of Pavan Thangudu, MD, though it is entirely a collaboration effort made up of clinical specialists from several departments and entities including local Emergency Services departments.
“PERT was created from a place of hope — hope that we could redirect the trajectory of likely fatal pulmonary embolism,” commented Thangudu. “It has grown into so much more. It has enabled us to come together as multiple specialties, multiple healthcare systems, as an entire community, to collaborate for more than just hope, but to save lives.”