Joe Sweeney (center) and his wife Bernadette (third from left) with members of the PPMC care team who helped save his life.
“Heart Attack Hill.” That’s what the Joe Sweeney and his wife, Bernadette, jokingly called it as they set off on their bikes to tackle the last leg of the 2016 Marshalton Triathlon in Chester County. Joe, a volunteer firefighter, was 58 years old at the time, in good physical shape, and a veteran of the triathlon, but it was Bernadette who pedaled her way into the lead. Everything took a turn, though, when Bernadette heard Joe yell her name and looked around to see him slipping from his bike. The hill had lived up to its name.
The next few moments were a rush of controlled chaos: the woman riding behind Joe happened to be trained in CPR and sprung into action without hesitation. After using an automated external defibrillator, a young paramedic quickly whisked him off to Chester County Hospital (CCH), while a state trooper shepherded a shell-shocked Bernadette to his car so they could follow the ambulance.
At CCH, Joe’s care team traced the heart attack to a clogged artery and placed a stent, but a second heart attack sent him spiraling towards heart failure. After nearly four hours at CCH, Joe was temporarily stabilized with a second stent and was placed on veno-venous extracorporeal membrane oxygenation (VV ECMO) to take over the work of his lungs and support his failing respiratory system. Still, his care team knew that his survival was dependent on a rapid transfer to the Trauma Center at Penn Presbyterian Medical Center (PPMC).
Upon arriving at CCH, “we found that not only were his lungs in bad shape, but he was experiencing almost total heart failure,” said William J. Vernick, MD, co-medical director of the Penn Lung Rescue program and director of Cardiac Anesthesia. “We switched him over to VA [veno-arterial] ECMO to better support both his heart and lungs.”
Joe was then transported by PennSTAR, marking the first successful flight transport of a heart patient utilizing ECMO. The PPMC team was ready and waiting, but while the flight was successful, the second stent failed almost immediately upon his arrival. Bumps in road continued to pile up: a bilateral occipital stroke, a medically induced coma, a 30-day bout of pneumonia, some time on the heart transplant list, a power outage that threatened to compromise his ECMO machine.… Through it all, his care team remained dedicated to providing the best treatment possible.
“It really was a multidisciplinary effort,” Vernick said. “Everyone had a hand in his care – the Lung Rescue team, the ECMO team, Cardiac Surgery, the ICU nurses, the perfusionists – and everyone was doing their part to improve a bad situation.”
“Even though they hadn’t seen all of this before – all of this at once – they were going to figure it out. They were in control and they were confident. They were good at not over-promising, but also at not scaring me,” Bernadette said. “More than 20 nurses took care of Joe, and each of them was also a godsend to me because they answered all my questions and took the time to explain things.”
Bernadette’s science background made her crash course in cardiovascular medicine easier to digest, and education served as her coping mechanism. The team allowed her to follow them on rounds so she could absorb as much information as possible to better inform her decisions about Joe’s care – and to stay sane, calm, and hopeful.
“I was just so amazed by how every member of his care team worked together. The doctors, the nurses, the social workers, the nutritionists, everyone – there was such a clear level of respect between every team member,” Bernadette said. “They all worked together to save him and to support our family.”
Bernadette recalls that just as CCH reached out to PPMC to determine the best course of action (“everything they did at Chester County just to keep him alive at that point was heroic; I’m so thankful”), PPMC also connected with other doctors and hospitals to review his case. That spirit of collaboration was critical, and it ultimately saved Joe’s life.
“This case was a really great example of how PPMC is able to leverage resources and coordinate efforts with hospitals throughout the region to treat even the sickest and most unstable patients,” said Jacob Gutsche, MD, system director for Cardiovascular Critical Care and co-medical director of the Penn Lung Rescue Program. “Teamwork and collaboration across locations and disciplines are key in a large health system that offers such a high level of care. That’s what makes such positive outcomes like this possible.”
Joe’s family was initially told to brace themselves for the worst, but after two weeks on ECMO, a month in the ICU, and hypothermic treatment – which cooled his body down to decrease the amount of oxygen his brain required and to counteract injury and cell death – his progress was promising.
“They told my family I’d probably have to go home with a VAD [ventricular assist device], but my heart healed remarkably well. They also thought the stroke might cause blindness, but I don’t have any vision problems,” Joe said. “I also went from being unable to raise my arms to walking without a cane or walker pretty quickly, and the really incredible thing is that my mental state is perfect.”
Amid all of the emotional upheaval, uncertainty, and stress, it was the testing of those abilities that offered a moment of levity. “I was getting all of these neurological tests done, and apparently I only really responded to Bernadette’s and my family’s voices and to a couple of voices I was used to, so that caused some confusion about whether everything was working correctly,” Joe said. “And then they were preparing me for some swallow tests, and the nurse needed to walk away for just a second. I fell sound asleep, and when she came back, she couldn’t wake me up. She started calling crash carts, and, well…” he trailed off sheepishly.
“He woke right up!” Bernadette said. “I had heard them call a code and the rapid response team, so of course I’m panicking, and it turned out that he was fine. He recognized the voice of a nurse on the rapid response team who said his name, but he didn’t recognize the voice of the new nurse who was preparing the tests.”
Selective listening aside, Joe has made pretty much a full recovery with the help of physical rehab. “I have some femoral artery damage in my left quad and some nerve damage in my feet, but all things considered, I’m 100 percent,” he said. “And it’s all because of the truly heroic efforts. They made my recovery possible, and I’m so grateful for everything.”
This past October, Joe and Bernadette returned to the triathlon, not to compete quite yet, but to express their gratitude to the bystanders who were critical to his survival. They have also made the rounds to reach out to his caregivers at CCH and PPMC (some of whom could hardly believe he was the same person), and they recently ended their “thank you tour” with a reunion with the PennSTAR crew.
“We don’t always get the chance to meet with former patients, so it was a really nice day, and it was great to see him doing so well,” said Tom Levins, RN, the clinical coordinator for PennSTAR who attended the reunion. “I think PPMC’s ECMO and Lung Rescue programs have really taken off and have made it possible for patients to have some excellent outcomes, so it was great to kind of ‘close the loop’ with someone who had received great care from Penn and who has had such a successful recovery.”