Cardiac Arrest: One Man Beats the Odds and Heads Home
It is exceedingly rare to survive a full cardiac arrest, but James Doganieri, of Pensacola, Florida, is one of the lucky ones. While traveling through Newark Liberty International Airport, only 6 miles from one of the nation's finest cardiac centers, his heart stopped. From the moment he fell to the floor in the airport terminal, Mr. Doganieri experienced flawless care that ultimately saved his life. Technology and training, as well as communication and coordination among EMS, the Emergency Department and the cardiac experts provided the highest level of care that meant the difference for Mr. Doganieri as he was traveling through the Garden State.
The last thing Mr. Doganieri remembers about that day was standing at the gate where he was scheduled to catch his connecting flight and the agent telling him that the pilot had pushed off early. “I missed my flight, but that pilot did me a great favor,” he recalled.
Alison Ashe, MD, an emergency medicine physician from Virginia Beach who had also missed her connecting flight, was first on the scene. “I heard a thud and I know that sound is never good,” she remembered. She ran over to help and arrived just as a paramedic also reached the scene. Mr. Doganieri was unconscious, and when Dr. Ashe couldn’t find a pulse, she shouted for someone to call 911 and bring a defibrillator. “As we were busy doing CPR, a medical bag and defibrillator quickly appeared on the floor next to us. We had to shock him twice, but within 5 to 10 minutes of collapsing, he was sitting up and insisting he was fine,” she said.
“I congratulate everyone who took part in his rescue and recovery,” said Port Authority Director of Public Safety/Police Superintendent Michael A. Fedorko. “The Port Authority Police Department began its defibrillation program in 1997. In 1999, under the direction of the late Captain Kathy Mazza, who was killed on 9/11, the program was expanded to equip all Port Authority facilities with life-saving portable defibrillators. Today, more than 1,200 defibrillators are available throughout all Port Authority facilities, and more than 1,700 police officers have been trained in how to use them. Dozens of lives have been saved, and we’re happy that this program played a role in assisting Mr. Doganieri.”
A Chain of Preparedness
Steve Goetz, a paramedic and senior member of the team who responded to the call that day, has answered hundreds of cardiac arrest calls in his 15 years with University of Medicine and Dentistry of New Jersey, The University Hospital EMS. “This was a perfect example of ‘chain of survival’ and the smoothest cardiac arrest call I’ve ever assisted on,” said Mr. Goetz. “He received immediate CPR and quick defibrillation, and that made the difference.”
Mr. Goetz and his team attached EKG leads to Mr. Doganieri and began transmitting the results to Newark Beth Israel Medical Center’s Emergency Department and Cath Lab simultaneously. En route to the hospital the situation was touch and go as Mr. Doganieri’s heart stopped twice, requiring more defibrillation and CPR.
“I was looking at a tracing of Mr. Doganieri’s EKG while he was still 15 minutes from the hospital,” said Eric Wasserman, MD, Chairman and Medical Director of the Department of Emergency Medicine at Newark Beth Israel Medical Center, explaining how the medical team was prepared for his arrival. “Mr. Doganieri underwent immediate resuscitation and was started on several medications to stabilize his heart. A call had gone out to the cardiac cath team and they were already beginning to assemble.” As the minutes passed, Mr. Doganieri became more alert and was stunned to learn that his heart had stopped.
The cardiac catheterization by interventional cardiologist Hector Rubinstein, MD, found that Mr. Doganieri had dense blockages and only a trickle of blood flowing to his heart muscle. The blockages in his coronary arteries were too extensive for treatment with catheter-based angioplasty and stents. A balloon pump that works temporarily to help the heart muscle squeeze blood through its chambers and pump blood at a higher pressure past blockages in the coronary arteries was inserted. The images gained from the catheterization were used by Ravindra Karanam, MD, cardiac surgeon at Newark Beth Israel Medical Center, as a road map for planning the six vessel bypass surgery that was performed the next day. “Scar tissue indicated that he had at least one previous heart attack,” said Dr. Karanam.
Cardiac Arrest May Strike Without Warning
“I had a complete physical in May and got a clean bill of health,” reflected the 65-year-old Mr. Doganieri, a retired Chief Petty Officer in the U.S. Navy who has always been active. Prior to his cardiac arrest he was riding his bike up to 15 miles a day, never experiencing chest pain, shortness of breath or any other symptoms of heart disease.
In a sober warning, Dr. Wasserman explained that unfortunately it is not unusual for someone to have a full blown cardiac event without prior symptoms. “Plaque builds up silently in the arteries and can rupture without warning,” he said. Dr. Karanam added, “It is possible to have significant blockages in the coronary arteries that are not detected with an EKG or a stress test, especially in people who exercise regularly. It is vitally important that people talk to their doctors about their risk factors for heart disease.”
Mr. Doganieri is looking forward to returning to his teaching position at the U.S. Navy Air Technical Training Center in Pensacola, FL. “I know how lucky I am and I am thankful for every one of the individuals who helped save my life.”
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