ECPR Proves Lifesaving for 52-Year-Old Cardiac Arrest Survivor

In the early morning hours of November 12, 2023, Aletah Whitman was awakened by what felt like an explosion in her left leg. She tried to stand, but lost consciousness. Aletah came to and managed to call 9-1-1.

“I was going in and out of consciousness, but I felt like my job was to get myself to the hospital. I knew I called 911, and they came, so I was just trying to stay calm,” she said.

Emergency responders broke down her door and rushed her to University Hospitals Cleveland Medical Center where the 52-year-old suffered a cardiac arrest.

In the U.S., 436,000 people die every year from cardiac arrest. People who experience a cardiac arrest outside of a hospital setting have only about a 10-percent chance of survival. Globally, cardiac arrest claims more lives than colorectal cancer, breast cancer, prostate cancer, influenza, pneumonia, auto accidents, HIV, firearms and house fires combined.

Every passing second is critical during a cardiac arrest. Even if you’re lucky enough to get to the hospital, your organs – most importantly your brain – are losing oxygen as the emergency team assesses your situation and works to address it. Often, by the time they address and sometimes even fix your cause, it’s too late for your brain, because it has lost neurological function due to lack of oxygen.

That’s where extracorporeal cardiopulmonary resuscitation (ECPR) comes in. ECPR is a method of cardiopulmonary resuscitation (CPR) that passes the patient's blood through a machine in a process to oxygenate the blood supply.

ECPR uses an ECMO machine (extracorporeal membrane oxygenation), which is a form of life support for people with life-threatening illness that affects the function of their heart or lungs. ECMO keeps blood moving through the body, supporting oxygenation of the brain and other organs. The device has been around for decades, but has not been used in this specific way until more recently.

Research published in The Lancet in November of 2020 was the first, community-wide ECMO-facilitated resuscitation program in the U.S. The research showed that 43 percent of patients in their program had functionally favorable survival rates at hospital discharge and at three months after discharge, significant compared to the 10 percent on average who survive a cardiac arrest in general.

“We’re early adopters of ECPR here at University Hospitals,” said cardiothoracic surgeon Yasir Abu-Omar, MD, who launched ECPR at UH Harrington Heart & Vascular Institute in 2020 and continues to lead the program. He is also Surgical Director of the Advanced Heart Failure & Transplant Center, and the Russ and Connie Lincoln Chair in Cardiovascular Innovation at UH Harrington Heart & Vascular Institute. “The study out of Minneapolis showed we could save lives with this program, so we began building it right away.”

To ensure a successful program, UH Harrington Heart & Vascular Institute created a system with coordination and collaboration from different experts and disciplines, such as emergency medicine, cardiothoracic surgery, interventional cardiology and critical care.

When UH Harrington Heart & Vascular Institute started its ECPR program, it was the only ECPR program active in Ohio and the first in Northeast Ohio (another system had a program that closed around 2020). As of January 2024, UH is the only ECPR program in Northeast Ohio and has a 66-percent neuro intact survival rate, which exceeds national averages.

“These patients are dead,” said Colin McCloskey, MD, a specialist in anesthesiology, critical care and emergency medicine at UH Cleveland Medical Center. “Usually when we use ECMO, we’re using it on a patient to keep them alive. But with our ECPR program, we’re using ECMO on a patient that has died to keep them alive while we work to treat them.”

By the time Aletah Whitman was brought to UH Cleveland Medical Center, the ECPR program had been in place for about three years. In the emergency department, personnel suspected a massive pulmonary embolism (PE).

“When Aletah came in, staff in the ED immediately identified her as a candidate for the ECPR program and our team, led by Dr. Abu-Omar, was mobilized,” said Dr. McCloskey. “She was cannulated and placed on ECMO to keep her alive while staff investigated her condition further.”

A massive PE was confirmed through a CT scan, and Aletah was transported to the cardiac catheterization lab, where she received a pulmonary embolectomy to remove the blood clots in her lungs.

“If we had not mobilized our ECPR team and placed Aletah on ECMO, she would not be here,” said Dr. Abu-Omar. “We could have cleared the clots in her lungs, but not quickly enough to keep her neurologic function intact unless we placed her on ECMO.”

Aletah spent four days on ECMO in the cardiothoracic intensive care unit before she regained consciousness and was removed from ECMO.

“I slept through the exciting bits,” she said. “My family and friends faced the fears. They revealed the seriousness of it in the days following and the odds that were shared with them. They eventually told me they thought they were coming to the hospital to say goodbye.”

She was discharged to a rehab facility and eventually returned home. Less than two months after her cardiac arrest she returned to work on light duty.

“So many things had to be in place for this to go right,” she said. “I know I’m so fortunate. I just wanted to get back to the life I had. I’m so grateful to UH for the amazing care.”

“The statistics for cardiac arrest are grim. Every life we can save is a win,” said Dr. McCloskey. “We’re thrilled to have started this program and positively impacted patients like Aletah and their families.”