Aletah Whitman went to bed early on a Saturday night last November. She'd spent the day cooking in preparation for the upcoming holiday. It was tiring, but she felt normal.
By the next morning, an unfamiliar sensation in her legs alarmed her. She threw her legs over the side of the bed in an attempt to stand, but remembers the floor quickly approaching her face as she passed out.
When she came to, she called 911 and dipped in and out of consciousness as she heard the paramedics knocking down her door.
Whitman, a 52-year-old East Cleveland resident, woke up days later at University Hospitals Cleveland Medical Center, disoriented and unsure how much time had passed. She had suffered a massive pulmonary embolism and had been on an ECMO (Extracorporeal membrane oxygenation) machine since her arrival at the emergency room, where UH has an ECPR (Extracorporeal cardiopulmonary resuscitation) program.
UH's ECPR program launched amid the COVID-19 pandemic in 2020, according to Dr. Colin McCloskey, a specialist in anesthesiology, critical care and emergency medicine at UH.
The American Heart Association updated its guidelines in December for cardiopulmonary resuscitation and emergency cardiovascular care, and determined ECPR should be recommended for cardiac arrest patients in hospitals with proper training and equipment.
McCloskey said ECPR is among the final life-saving options for patients like Whitman, noting that the chances of surviving a major cardiac arrest are 10%. So far, UH has seen a 66% survival rate within its ECPR program, which is higher than the 43% survival rate reported during a 2020 clinical trial program at the University of Minnesota.
"ECPR patients, by definition, they're dead," McCloskey explained. "They don't have pulses. They have failed standard resuscitation and if this isn't offered, those patients almost all succumb. They almost all die."
ECPR patients are placed on ECMO machines, which oxygenate and circulate the blood by taking over the functions of the heart and lungs. The machines give emergency room doctors more time to identify what's happening with patients suffering cardiac events without risking further brain damage.
"What really causes death in the majority of these patients is that the brain is very sensitive to periods when it's not getting blood supply," said Dr. Yasir Abu-Omar, surgical director of UH's Advanced Heart Failure & Transplant Center. "Oxygenated blood is to protect the brain and keep them alive until we can correct the primary cause that caused the cardiac arrest."
Whitman spent nearly four days on ECMO in UH's cardiothoracic intensive care unit before she regained consciousness and was removed from the machine. She doesn't remember any of that, but realized something serious had happened to her when her family came to visit from Louisiana.
"I slept through the exciting bits and they had to experience the roller coaster of events," Whitman recalled. "They took a couple of days to kind of gently tell me just how serious things were."
Whitman said her brother even kept a journal detailing the events of her hospitalization, from preparing for his trip to Cleveland to hearing her prognosis.
"Seeing that in black and white when I read it later was pretty jarring, to see how close I came to not making it at all," Whitman said.
While ECMO machines aren't new — they first surfaced in the 1960s, this particular use for them on cardiac patients is relatively new. McCloskey said he hopes UH's success will tempt more hospitals to implement ECPR programs.
"This is something that is no longer a science problem. This is a system issue," he said. "We have the expertise. We have the technology in 2024 to have this happen, but your [hospital] system has to be trained, experienced, mature enough to deliver this care. The beauty of it is, with this survival data, you're going to see movements in the standard of care in mature systems for these very niche patients that this should be offered."
Whitman, who said she had never heard of ECPR or ECMO prior to her case, noted the ease of her recovery after her release from the hospital. After 15 days, she was able to return home and get back to work quickly. By Christmas, she was able to welcome visiting family, attend a Cleveland Monsters hockey game and hit the batting cages with her nephew.
"Hopefully my experience will inform future experiences, other patients who have similar problems to mine," she said. "I'm thrilled for myself, obviously, but I'm also thrilled that this feels like an advancement or a new way to think about folks who come in the emergency room in my situation."
