John DeBusk didn’t realize it, but the active and trim 61-year-old retiree also was a heart attack looking for a place to happen. Thinking he’d been poisoned while spraying for carpenter bees, DeBusk drove seven miles from home to Parkwest Medical Center’s emergency department, circled the emergency parking lot and finding no open spaces, exited the lot – and his life.
“It was like somebody just turned off a switch,” said DeBusk, whose heart suddenly stopped while his Mercedes SUV kept moving until it crashed into a ditch several yards away. “The next thing I knew it was Friday, and this happened on a Monday. It was like an alien abduction.”
Even today, three months later, DeBusk is still trying to sort out details. But this much he does know: his heart stopped beating, his lungs and kidneys stopped working and Parkwest Medical Center brought him back to life – three times.
“I’d like to know the names of the people who helped, but I don’t,” he said recently. “The crash must’ve made enough noise and commotion that security came down there. At the same time, I am told, there was an ambulance coming down the frontal road and the EMS crew saw what was going on, and they dragged me up on the grass. I was already dead at that point.” As he lay lifeless, his heart was shocked back into rhythm with a defibrillator, a breathing tube was inserted down his throat and he was rushed into the hospital’s emergency department where cardiologist Ogei Yar, MD, quickly determined he had suffered a heart attack. DeBusk was whisked off to the heart catheterization lab where the retired engineer had once worked installing and servicing the very medical equipment that would help save his life.
Interventional cardiologist Ayaz Rahman, MD, recognized that Mr. DeBusk had a rare, life-threatening condition called cardiogenic shock before initiating the angiogram. Cardiogenic shock occurs when the heart’s left ventricle has been so damaged that it is unable
to pump blood to other critical organs such as the kidneys and lungs.
To maintain DeBusk’s blood pressure, Dr. Rahman inserted a miniature heart pump (ventricular assist device) through an artery in his patient’s leg and into the left ventricle. That should have provided sufficient blood flow as he worked to open the blocked right coronary artery and insert a heart stent. It didn’t. “Despite opening that artery, his blood pressure did not respond the way we thought it should,” said Dr. Rahman, adding that DeBusk’s heart arrested and had to be defibrillated twice more – even with the left heart pump in – while work continued on the artery.
“We did what’s called a right heart catheterization to assess the health of his right ventricle, and we found that his right ventricle was also failing. So we put in a right-sided pump and it was only after that things started getting better, and he began to stabilize with both heart pumps in
Five days later, DeBusk awakened in ICU to see his sister, friends and former coworkers at his bedside. “The first words I hear them saying were, ‘You’ve had a heart attack and you’re in the
hospital,” said DeBusk. “I thought it was the same day – Monday the 15th – and then I found out it wasn’t. I literally thought, ‘How did I even get here?’”
He remained in Parkwest Medical Center 12 days before being released to continue dialysis treatments three days a week. After his kidneys fully recover, he will return to Parkwest to have another stent placed in his circumflex artery, which remains 70 percent blocked. “Dr. Rahman said it’s not life threatening, but it needs to be fixed,” said DeBusk. “They saw it, but didn’t
have time to do that one – they were too busy trying to keep me from dying again. “Dr. Rahman is one of the best ones up there,” said DeBusk, who was already acquainted with many Covenant Health doctors from his engineering service calls. “I hit the lucky draw. Of course, everybody at Parkwest was great – I give them 10 out of 10. I don’t know what more you could ask. They are so nice and kind. It’s nice to know that if you’ve got to go through this that you have people who know what they’re doing.”
From the security guards who rushed to the scene and the passing ambulance crew to the army of professionals inside Parkwest, it was a show of teamwork that left Dr. Rahman beaming and DeBusk breathing. Emergency care doctors, cardiologists, pulmonologists, nephrologists, RNs,
LPNs, rehabilitation therapists, lab technicians and other clinical staff were all part DeBusk’s continuum of care. “I feel extraordinarily privileged to work with such a great group of people that were able to recognize, treat and work in unison to save this gentleman’s life,” said Dr. Rahman. “It honestly is a privilege to work at an institution like this with such amazing people.”
Covenant Health on Alert for Cardiogenic Shock
Cardiogenic shock as experienced by John DeBusk does not always accompany a heart attack, but when it does, Parkwest Medical Center is able to find it fast. That’s because Parkwest is one of three Covenant Health hospitals (Fort Sanders Regional and Methodist Medical Center are the other two) participating in the National Cardiogenic Shock Initiative (NCSI), a collaboration
between about 50 hospitals nationwide with the goal of improving mortality in cardiogenic shock patients.
Cardiogenic shock occurs when the heart suddenly stops pumping enough blood because the main pumping chamber, the left ventricle, has been damaged and blood pressure becomes dangerously low. In rare cases, it can happen to the bottom right ventricle, which supplies blood to the lungs. Most often, it is caused by a heart attack but can also be the result of other cardiac issues such as myocarditis, endocarditis, arrhythmias or pulmonary embolism.
Cardiogenic shock is so life-threatening that historically it carried a mortality rate of 50 percent. Physicians traditionally relied on slow-acting medications and less effective mechanical devices
to keep the heart functioning, but often the blood circulation was not enough to keep vital organs working properly. With the launch of NCSI, however, participating hospitals have seen survival rates improve to almost 80 percent.
Hospitals in the initiative follow a defined protocol for treatment. That protocol includes quick placement of a miniature heart pump, percutaneous intervention, and right heart monitoring to rapidly reduce the use of drugs that force contractions of the heart. Participating hospitals share their data regarding efficacy and patient outcomes among themselves and the public. “Since joining the shock initiative, we have become more sophisticated in recognizing shock and also treating it aggressively, because early data shows the quicker you recognize it and the quicker you act, the better the outcomes are,” said interventional cardiologist Ayaz Rahman, MD. “Mr. DeBusk was a very healthy individual with no real cardiac history and because of this therapy, we expect him to have a very fruitful and