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Tuesday, December 20, 2016

The Easter Miracle

Posted By: Advancing Care

How a first responder’s persistence and Good Samaritan Hospital’s cardiac care saved a deacon’s life

By Mary McIver Puthawala, RN, BSN

To Ed Ilarraza, Easter had always been a time of celebration. However, in 2010, as he stood greeting people who entered his church in New City for the early-morning Easter service, the 58-year-old deacon didn’t realize he and his family would have far more to celebrate in the days to come.

After Easter service began, Ilarraza began to perspire — one of the signs of an impending heart attack. Though he’d decided to ignore the warning signs, an EMS paramedic who volunteers at the church did not. Instead, the first responder pulled him aside and asked if he was okay.

“He wanted to call an ambulance, and I said, ‘There’s no need; I’ll be ok,’” Ilarraza remembers. “Then, he wanted to call my family, and I said not to bother. He then got close to my face and said, ‘If you don’t feel well, you need to tell me,’ and I replied that I didn’t feel well.” The last thing Ilarraza remembers is being placed inside the ambulance; that is where his heart stopped the first time.

Immediately, the paramedics applied defibrillator paddles to Ilarraza’s chest and sent electrical shocks to his heart in an effort to restore a normal heartbeat, performing the procedure several more times en route to Good Samaritan Hospital, a member of the Westchester Medical Center Health Network (WMCHealth) in Suffern.

Cardiologist Cary Hirsch, MD, FACC, President of the Good Samaritan Hospital Medical Staff and Co-Director of Cardiac Catheterization, was waiting for Ilarraza at the hospital. “He received shocks several times in the Emergency Department, and we took him to the cardiac-catheterization lab, and there, he had several more cardiac arrests. Eventually, we were able to stabilize his heart enough to perform the catheterization that opened up the critical coronary arteries.” In total, Ilarraza received 17 shocks to restart his arrested heart.

Finally, with blood flow restored to the heart tissue, Ilarrazza’s heartbeat steadied on its own. However, because it had stopped so many times, there was a very real danger that his brain had missed several minutes of adequate blood supply, which often results in severe and permanent brain injury.

In order to minimize whatever brain trauma may have occurred, Ilarraza was treated with a hypothermia protocol. The process involves inducing the patient into a coma, then lowering the body temperature to between 89 and 93 degrees for a period of 24 to 36 hours. This process effectively “ices” the brain cells in the hope that any additional critical damage that is prone to occur after a brain injury (in this case due to lack of oxygen) might be averted.

While Illarraza’s heart was now stable, Dr. Hirsch warned the deacon’s wife and son that his medical team wouldn’t know the status of his brain function until he was brought out of the coma and that they should be prepared for the possibility that he might not recognize them when he regains consciousness.

“My family was told not to hold out too much hope,” says Ilarraza.

Three days later, Ilarraza was carefully and slowly rewarmed, while his anxious family waited and prayed. “When I woke up on Wednesday,” he says, “I thought it was Sunday afternoon. My wife was there and asked if I knew who she was. I thought, What’s wrong with her? We’ve been married over 25 years! She brought my kids in and asked if I knew who they were. Then she told me what had happened.” Ilarraza remained skeptical. It took until the next day, when the press wanted to interview the man who had experienced the Easter miracle, that he finally realized just how fortunate he was.

Although he’d suffered a heart attack, major brain damage had been averted.

The event understandably changed Ilarraza’s life physically, mentally and spiritually. “There’s more to being here than making and spending money,” he says. In the months afterward, he dropped a two-pack-a-day smoking habit and modified his diet. Soon, rehab began to help him recover. Six months later, he ran a half-marathon. A year after that, he ran his first full marathon. “Life is better than it’s ever been,” says Illarraza.

The facilities at Good Samaritan were instrumental in Ilarraza’s remarkable recovery, Dr. Hirsch adds. Good Samaritan Hospital’s cardiovascular program includes open-heart surgery, a cardiac-catheterization lab, emergency angioplasty, electrophysiology studies and a pacemaker clinic.

“We do it all,” says Dr. Hirsch. “We’ve been doing this 10-11 years, and it takes a big commitment on the part of the hospital to maintain a facility like this.” Qualified staff, from technicians, to nurses and doctors must be available 24/7. And they have to be able to act fast; typically, as in Ilarraza’s case, they need to get patients to the cardiac-catheterization lab within 30 minutes.

Dr. Hirsch says that although Ilarraza’s recovery is remarkable, many people do recover and do well long-term. Says Dr. Hirsch: “We never give up trying to save them all.”

How to Save a Life: Hands-Only CPR

Since the vast majority of sudden cardiac deaths don’t happen in the vicinity of a medical professional, CPR performed by a bystander is often a victim’s best chance. That’s where Hands-Only CPR comes in. According to Julio Panza, MD, Chief of Cardiology at Westchester Medical Center (WMC), the flagship of the Westchester Medical Center Health Network (WMCHealth), Hands-Only CPR is a simplified yet lifesaving version of CPR that is performed without mouth-to-mouth resuscitation, until EMS or other providers can treat the victim with an Automatic External Defibrillator (AED), a device that uses electric shock to restore normal heart rhythm.  Dr. Panza explains that for victims of cardiac arrest, the less time between initial collapse and the first chest compression, the greater the likelihood of resuscitation, survival and retention of quality of life. “But sometimes the people who witness cardiac arrest don’t attempt CPR because they are apprehensive about performing the mouth-to-mouth ventilations that are a part of traditional CPR. Research demonstrates that the most important part of CPR is keeping circulation going, [not the mouth-to-mouth], and that is what you do with Hands-Only CPR,” Dr. Panza explains.

If you see someone collapse because of cardiac arrest, Dr. Panza suggests calling 911 first, followed these two simple steps, even if you’re not trained in Hands-Only CPR:

  • Start pushing hard and fast on the center of their chest.
  • Don’t stop until help arrives or they regain consciousness.