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Volume 60
Number 8
October 2009

HEADLINERS
 






 

Getting Patients Out There
The Mechanical Circulatory Support Device Team aids one of the largest artificial heart pump programs on the East Coast.

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Patients
From left: Susan Ullrich, Pamela Meyer and Dennis Rivard make up the cardiac assist device team.

Tucked into a small office on Carnegie 2 are three employees who serve as lifelines to end-stage heart failure patients in more ways than one.

Meet the Hopkins Hospital’s Mechanical Circulatory Support Device Team. Nurses Pamela Meyer and Susan Ullrich, and perfusionist Dennis Rivard, make it their mission to help these critically ill patients optimize their lifestyles while living with an artificial heart pump.

"Our philosophy is to get patients out there, back to their daily living," says Meyer. "They really can have a great quality of life—they can fly, they can travel."

The pumps, known as ventricular assist devices (VADs), help the heart pump blood to the body. The pumps can be used until a donor heart for transplant becomes available or as "destination therapy" for patients who choose not to get a transplant or do not qualify for a transplant.

The devices are implanted on the heart surgically and are operated by an external computer worn on a patient’s belt. They’re powered either by batteries or by plugging into an electric outlet or a car’s cigarette lighter.

"There’s an enormous emotional adjustment to this," Meyer says. "There is no other medical device for outpatients that requires the constant vigilance that these pumps do."

Meyer and colleagues educate patients and their families on how to live with the devices and help patients deal with their fears: that they may not be able to operate the device correctly despite the team’s extensive instructions; that the pump will suddenly malfunction and they will die; that people will stare at them because they’re carrying portable battery packs, with alarms that might beep during a movie or dinner outing.

The device team, with more than 75 years’ experience at Johns Hopkins among them, is on-call 24/7 for at least 30 patients at a time, including middle-aged adults who have been living with heart failure for years, seniors too old for a transplant, teenagers recovering from a virus that attacked their heart or cancer patients with chemotherapy-induced heart failure. Sometimes the team gets a heads-up that a patient is coming; other times patients have an acute heart failure episode that sends them to the hospital, and they wake up with a pump already in place.

Because Hopkins has one of the largest VAD programs on the East Coast, currently using five types of devices, the team must keep up to date on emerging technologies. They advise colleagues at other institutions and speak at national meetings.

But most regular days find the team multitasking. They round on hospitalized patients and see outpatients in the clinic. They provide emotional support for patients’ families. They answer questions on subjects as varied as medication refills, insurance questions and life-threatening emergencies. Rivard provides technical support—he and other perfusionists assist during the implantation surgeries and assemble the devices. And, before patients are discharged, Rivard does extensive outreach to their local communities, alerting the EMS services and community hospital emergency rooms that a pump patient will be in their area.

"We are patients’ primary support," Rivard says. "For good or bad, we become their emotional lifeline. Our decisions determine whether they will live. It’s both stressful and rewarding."

Adds Ullrich, "You find yourself managing a whole life. It has given me a lot of respect for patients and what they will do for a better quality of life or for one more day of life."

Despite the stressors, the trio agrees that the best part of the job is enabling patients to meet their new goals, like traveling or walking a daughter down the aisle. One patient finally took his wife on a cruise he had been promising for years. "We’re crafters as well as clinicians," Rivard says. "We look at their goals and try really hard to achieve them."

– Karen Blum

 

 

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