Back from the dead twice

Feb 20 2009

"I died twice," says a teary-eyed DeWayne Lark, "If I didn't believe in miracles before, I believe in them now."

Lark was saved by a state-of-the-art strategy to treat heart attack patients that requires lock-step collaboration among teams in the ambulance, emergency center and cardiac catheterization lab. In Lark's case, the teams on board were The University of Texas Medical School at Houston, the Memorial Hermann Heart and Vascular Institute - Texas Medical Center and the Houston Fire Department.

The response strategy they employed is called PATCAR, which stands for Pre-Hospital Administration of Thrombolytic Therapy with Urgent Culprit Artery Revascularization.

"The strategy was designed to test the idea that the use of a clot-busting drug before the patient arrives at the hospital, followed by heart catheterization, reduces the chances of death in heart attack victims," says Richard Smalling, MD, PhD, professor at UT Medical School at Houston and director of interventional cardiology at Memorial Hermann - Texas Medical Center.

For Lark, this "idea" has been tested-and just in time.

Six months ago, Lark remembers he was running a community meeting when something just didn't feel right. "I suddenly got really thirsty. Then I began getting dizzy and started sweating. Next came the vomiting and pain in my chest," says Lark.

Lark managed to call 911. Upon arrival, the emergency medical technicians quickly evaluated him as having a heart attack and set PATCAR into motion.

The first step is notifying the hospital staff of the patient's condition. "It's kind of like a fire alarm," says Mary Vooletich, a registered nurse and clinical trial program manager at the UT Medical School. "An alarm literally goes off and everyone in the ER sort of puts their boots on and goes into action."

In the ambulance, EMTs performed an electrocardiogram, (ECG or EKG) on Lark. The results of that test were sent from the ambulance to the emergency center at Memorial Hermann-Texas Medical Center, where they were reviewed by a physician.

Once it was clear that Lark was suffering a heart attack, the physician told the EMTs to give Lark a clot-busting drug called Retavase followed by a dose of Plavix, a blood thinner. Both drugs helped stabilize Lark on his way to the hospital.

"Getting that artery open as fast as possible was the most important thing," Vooletich says. "He had a big, horrible heart attack in one of his upper arteries called 'the widow maker'. When he got to the emergency center, he arrested."

He was revived and rushed to the catheterization lab, where diagnostic and treatment procedures using a coronary catheter take place. On the way, Lark arrested a second time in the elevator. His emergency team began CPR to keep blood flowing to the heart muscle. Once in the cath lab, Smalling inserted a tiny balloon into the blocked artery.

Arterial blood flow was restored and Lark's heart came back to life.

"Everything we had prepared for and trained for over the last six years of using this process came into play with Mr. Lark," Smalling says. "The emphasis here is that it's a community effort. We had three or four different teams respond to a heart attack patient. This allowed us to get his heart started quicker and I would venture to say that there are very few places in the country that could have done this."

As for Lark, he says his experience has sparked some changes in his life. "How could it not? It was scary. First the heart attack, then weeks of physical therapy," Lark says. He quit smoking, cut out fried foods and sugary snacks and tries to lower his sodium intake. He walks on a treadmill three times a week. And he is taking medications that will reduce his chances of a repeat attack.

The hope is that one day PATCAR will become standard practice in all hospitals that have cath labs, says Smalling. For PATCAR to become the standard of care, it must be proven to be safe and effective. To do that, a large multi-center randomized study must be completed. Smalling's research team is in the process of obtaining that funding. The preliminary results of PATCAR were published in the October 2008 issue of the Journal of the American College of Cardiology.

"I'm so grateful to everyone," Lark says in an emotionally-charged voice. "This was truly a miracle."