PATIENT EXPERIENCE Perfectly coor dinated emergency care: Teamwork saves Amber

Thanks to extraordinary care at Bryan, art teacher Amber Reining is back in the classroom at West Lincoln Elementary School.

Perfectly coordinated emergency care Teamwork saves Amber

Amber Reining, 40, of Lincoln, suffered a medically complex heart attack in the Emergency Department at Bryan East Campus last August, which caused her heart to stop for four hours.

Bryan doctors and nurses resuscitated Amber with such precision that six months later she feels well — a rare medical success for someone whose heart stopped for so long. A mother and elementary school art teacher, Amber is now back with her young children and family, back at work, back to her life. Subtle symptoms preceded severe chest pain Amber woke early that day with vague chest pains and a sense something wasn’t right. Her husband Eric took her to a local urgent care medical clinic, but like many women in early stages of heart attack, her symptoms were not obvious, and her initial electrocardiogram (ECG) heart testing results looked normal. “During a heart attack, women’s symptoms are typically more subtle than men’s,” says Bryan emergency medicine physician Jay Meyer, MD. “Women’s heart attack symptoms can start with something as mild as chest discomfort or nausea, then become more like men’s typical symptoms of severe chest pain over a period of hours.”

Amber went home to rest, but her chest pain returned, far worse this time. Eric quickly drove her to see their family nurse practitioner, who found Amber’s ECG heart testing results now were abnormal and sent her to the Emergency Department at Bryan East Campus for further evaluation and treatment.

As Eric parked the car, Amber walked into the Emergency Department. Then, her heart stopped beating. It would not regain full function for several days. Not giving up

Maxine Turvey, RN, met Amber as she walked through the door that day. Within a minute or so, Amber collapsed into her arms. “I lowered her to the floor and found she had no pulse. My nurse manager and I immediately began chest compressions and rescue breathing on her to start cardiopulmonary resuscitation,” Maxine says.

“CPR continued under the direction of Dr. Meyer,” says Emergency Department nurse manager Mona Reynolds, RN. “We also activated our ‘ cardiac alert ’ pr otocol, which lets our emergency and car diac catheterization teams know that a

patient has had a heart attack, and it brings a cardiologist and other key staff to the scene right away.” The team responding to the alert included Bryan Heart cardiologist Matthew Johnson, MD, and nurses and staff fr om the car diac catheterization lab, sur gery, pastoral care and perfusion services. Over the next four hours, more than 20 doctors, nurses and other staff worked non-stop in the cath lab to save Amber’s life, delivering chest compressions, rescue breathing, shocks and intravenous medicines in a steady effort to r estart her heart . Mona says, “We were absolutely determined to save Amber, and we were not giving up.” Extraordinary intervention “Amber’s heartbeat came back briefly , only to stop again and again,” says cath lab manager Lynn Fitzgerald, RN. Eventually her heart stopped responding entirely — a state in which blood and critically essential oxygen and rescue medicines reached Amber’s brain and the rest of her body “I’m forever grateful and am making the best of each new day I’m given. It is truly a gift.” – Amber Reining

Maxine Turvey, RN; nurse manager Mona Reynolds, RN; Jay Meyer, MD; Shirley Mohr-Burt, Bryan Heart APRN; and assistant nurse manager Dan Benson, RN, were among the first to respond to Amber’s emergency.

only through the CPR compressions the Bryan team performed on her heart. Extraordinary intervention was now needed to save Amber’s life.

Aware that her heart might be too damaged by her heart attack to ever beat normally, Dr. Johnson made the key decision that Amber’s best chance at survival might be heart transplantation, if a suitable heart was available.

Dr. Johnson placed Amber on extracorporeal membrane oxygenation (ECMO), a treatment in which a complex machine, similar to that used in openheart surgery, pumps and oxygenates a patient’s blood outside the body, allowing the heart and lungs to rest. With the ECMO machinery in place, Amber was urgently transferred to the University of Nebraska Medical Center (UNMC) in Omaha for consideration for heart transplantation.

Amber’s happy ending Two days later, Amber’s story took an unusual, happy turn.

“Because of our rapid use of ECMO,” explains Dr. Johnson, “her heart was able to recover to full function.”

Amber’s heart began to beat on its own again. She didn’t need a heart transplant.

After her long ordeal, Amber’s first memory was of waking up in the intensive care unit at UNMC with her family at her bedside. The greatest concern for Amber’s doctors and family was whether her cardiac arrest affected her brain function, but her first words put this worry entirely to rest.

“I remembered it was my Mom and Dad’s wedding anniversary that day and said, ‘I’m so sorry you spent your anniversary here with me in the hospital.’ I think they cried and laughed

at the same time — it was a huge relief that I woke up and that I was thinking pretty normally considering all I’d been through.” she recalls.

“Now, six months later, I’m feeling surprisingly well after the heart attack and the whole long resuscitation. I don’t feel I’ve had any bad effects, and I’m functioning normally, with all my long

term memories.

“The heart attack was due to damage that developed in one of my large heart vessels. My doctors are controlling the problem with medication and reevaluating me often and planning further treatment.”

But that wasn’t the end of Amber’s care at Bryan.

Cardiovascular technologist Austin Byleen, interventional cardiologist Matthew Johnson, MD, and Cardiovascular Specialties RN Katelynn Danek used an ECMO system to oxygenate Amber’s blood because her heart wasn’t beating on its own. “In addition to everything related to the heart attack, another medical scare had me returning to Bryan,” she says. “About three weeks after returning home, I had chest pains. So I was worried I was having a second heart attack! We went back to the Emergency Department, and I was relieved to find out the pain was due to gallstones.”

Because of the severity of her symptoms and to avoid chest pain confusion going forward, her gallbladder was removed when she was strong enough for surgery.

“It’s a rare success after the kind of lengthy car diac arr est Amber suffer ed for a person to feel and function as normally as she does. That’s because patients often have some degree of brain injury if oxygen didn’t reach their brain when their heart stopped pumping. This is a great concern for patients who’ve gone through CPR,” Dr. Johnson adds.

“Amber beat these odds partly because she has youth and health on her side, but also, and of key importance, because we started her resuscitation instantly, with perfect coordination between our team members, right up to her transition to ECMO. It worked liked clockwork and is an excellent success story.”

“I’m in awe at how the doctors and nurses at Bryan worked so tirelessly to save my life, refusing to stop,” says Amber. “I can’t put into words how thankful I am to all of them for their extraordinary care. I’m forever grateful and am making the best of each new day I’m given. It is truly a gift.” n

To learn how you can support the work of Bryan Health, please contact the Bryan Foundation at 402-481-8605.