In her 44 years working in the Tufts Medical Center Emergency Department (ED), Registration Team Leader Bernice Soohoo has seen just about everything. But Soohoo never could have anticipated the shock she received when registering a gravely ill cardiac arrest patient on October 24, 2015. When Soohoo saw the young man’s name and birthday, she did a double take; she had registered her own nephew.
Gregory Wong, 33, doesn’t remember a thing about that Saturday. He has no memory of waking up that morning, showering, or going to work at a wine tasting event at the Castle at Park Plaza in Back Bay. And he has no recollection of feeling ill, collapsing and going into sudden cardiac arrest. After EMTs spent 15 minutes on site working unsuccessfully to restore his pulse, Wong was rushed to Tufts Medical Center.
Willing a Heart to Beat
In the Tufts MC ED, nurses Jason Brauninger, RN and Megan Esch, RN immediately began administering CPR, but Wong couldn’t maintain a pulse. Soohoo was told his prognosis was grim; if a patient can’t be resuscitated in 30 minutes, it is typical emergency protocol to discontinue efforts to save them.
“We started cardiac resuscitation, gave him medications and did everything possible to try to get his pulse back and his heart beating,” said Emergency Medicine Physician Nadine Youssef, MD. “As an ED physician, you try not to think the worst and always hope you can do something. But less than one percent of people in this situation make a full recovery.”
After a sustained, dedicated effort from the ED team, Wong’s pulse was finally restored nearly an hour after he first went into cardiac arrest. But even though his heart was beating, his oxygen levels remained dangerously low. So a team of cardiologists, critical care physicians, intensivists and interventionalists were called down to the ED to discuss whether Wong would be a good candidate for ECMO—a machine designed to take over the function of a patient’s heart or lungs, pumping blood or breathing for them, allowing those vital organs to rest and recover. But while it can be a real difference maker, ECMO is not without its risks.
“ECMO saves lives, but there are significant dangers associated with its use,” said Respiratory Therapist/ECMO Specialist Al Fantasia. “Even if you do everything right, there is still a high mortality rate. In Gregory’s case, conventional therapy had failed and the benefits of using ECMO far outweighed its risks.”
Going on ECMO
Wong was transferred from the ED to the cardiac catheterization lab, where cath lab staff assessed his heart function. Wong’s oxygen level remained extremely low, so a team composed of Director of Cardiovascular Critical Care Service Adel Ghuloom, MD, Fantasia and Cath Lab Nurse/ECMO Specialist Samantha Asber, RN connected Wong to the ECMO machine to support his lungs and attempt to increase his oxygen levels. After an hour, Wong’s oxygen had improved enough to allow him to be moved to the Cardiac Care Unit (CCU), where the ECMO machine was adjusted at the bedside to support his heart, which was failing again, in addition to his lungs.
“Doctors told me that Greg was the sickest patient in the hospital and there was only a 50 percent chance he would survive,” said his mother Claire Wong, who works at Tufts MC as a Transplant Surgery administrative coordinator. “And even if he did pull through, there was a high likelihood of long-term health consequences. It was very scary to hear.”
But Wong continued to defy the odds. ECMO kept him alive for four days as his heart and lungs recovered and grew stronger. After an additional 12 days in the CCU, Wong was discharged to rehab on November 9; by Thanksgiving, he was walking, talking and eating on his own.
“I’m so thankful and proud of the extraordinary care our medical team provided to my nephew,” said Soohoo. “Every person involved was so supportive and thoughtful and many still ask about Greg months later. This hospital really is like a family.”
Doctors were never able to determine a reason for why his heart suddenly stopped beating, so on December 7, 2015, Wong returned to Tufts Medical Center to have
a cardioverter defibrillator implanted to ensure a repeat episode would be pre- vented. While at the Medical Center, Wong visited the CCU and the ED to thank those responsible for saving his life. They were all in awe of how well he was doing.
“I was really shocked when I saw him. He was walking on his own—it was amazing,” said Asber. “I couldn’t believe how quickly he recovered. It just goes to show the remarkable ability of a young person’s body to bounce back when given the chance. You would never have known what he went through just six weeks earlier.”
“I have never seen a patient with this type of cardiac arrest recover this well,” said Dr. Youssef. “This is why we become doctors—to make this type of impact and save someone’s life. It really validates why we do what we do.”
So Much Life Left to Lead
Now, more than nine months later, Wong is doing well and has returned to a normal life, including resuming a full time work schedule in February. Every day he gets a little stronger and has slowly gained back the 20+ pounds he lost during his time in the hospital. While Wong has a two and a-half week gap in his memory following the incident, his recollection of events before and after is as sharp as ever.
“The speed and level of my recovery is a testament to the care I received at Tufts MC,” said Wong. “I don’t know if I would have survived if I went to any other hospital. So many people there—nurses, doctors, support staff – all went above and beyond for me. They saved my life. For that I will forever be grateful.”
“In 23 years as a respiratory therapist, I have seen less than five people be that sick and live – and none of them recov- ered as well as Gregory,” said Fantasia.
“It just shows the resolve and dedication of our teams here. For the rest of my life, I will always look back on this case and say, ‘wow.’”