At 21 years old, Melanie Rodriguez did not expect to be in a medical transport helicopter on her way to get life-saving treatment at Keck Medicine of USC’s CardioVascular Thoracic Institute. But a cardiac ablation for an irregular heartbeat at another hospital had developed complications that needed Keck Medicine’s specialty care.
While still a freshman in high school, Melanie was diagnosed with bigeminy, a type of irregular heartbeat, after she felt sick and passed out in a hallway at her school in the San Fernando Valley. She lived with the condition for several years before her doctor recommended that she have the ablation procedure.
“The doctors thought I should have it done because I was young and it would be better to do it while I could bounce back right away,” recalls Melanie.
If all goes well with a cardiac ablation, it can be a quick recovery. Some patients are discharged the same day and quickly return to normal life. Unfortunately, this was not the case for Melanie when the ablation was performed at her community hospital. Still, she was released and returned home.
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She soon developed blood clots, which is a possible side eﬀect from this procedure. One of her feet was swollen and she was struggling to get around. Looking back, she says her head was telling her that she must be alright because she had been discharged from the community hospital. Her gut, on the other hand, was telling her that something was really wrong.
Knowing that she was supposed to walk as part of her recovery, she took a walk with her boyfriend Richard Gutierrez a few days after going home. As the young couple sat down to eat lunch, she went pale and he caught her just as she was about to pass out.
The Right Expertise to Help
An ambulance sped her to the nearest hospital where an emergency room doctor instantly recognized that she had developed blood clots that were life-threatening. Although they didn’t have the proper training or equipment to treat her, he promised Melanie that he would ﬁnd help. He made a call to the USC CardioVascular Thoracic Institute. Even though Melanie had never been seen at Keck Medicine before, he knew they had the right expertise to help her.
By the time the helicopter that carried Melanie to Keck Hospital was met by Ray Matthews, MD, professor of clinical medicine at the Keck School of Medicine of USC and chief of the division of cardiovascular medicine, Melanie was on a ventilator because she was no longer able to breathe on her own. The blood clots in her leg had moved into her lungs, sending her into cardiogenic shock. Because the clots were so large, her body was no longer capable of circulating blood. In addition to aﬀecting her heart and lung function, this also caused her kidneys and liver to fail.
Though blood clots are common and many community hospitals can safely and eﬀectively treat them, Melanie’s were too big and too extensive to be treated at most medical institutions. Saving her life would involve bringing together two areas of expertise, so Dr. Matthews reached out to Amy Hackmann, MD, assistant professor of clinical surgery at the Keck School and director of mechanical circulatory support at Keck Hospital, to keep Melanie alive long enough so that he could treat her.
“She needed an unusual treatment for an unusual problem, which is essentially what we do,” says Matthews.
A Shot at Survival
Dr. Matthews is one of only a few physicians in the area with experience treating large blood clots. Treatment can involve inserting a catheter into the lung vein, which would drip a medication directly onto the clot to dissolve it. This procedure also carries signiﬁcant risk because the medication used is stronger than other blood thinners, but it was also Melanie’s only shot at survival. Unfortunately, dissolving large clots can take a few days and Melanie did not have that much time.
“We needed to get her on ECMO or she probably wouldn’t have survived,” explains Dr. Hackmann. ECMO, or extracorporeal membrane oxygenation, is performed by a machine that works in place of the heart and the lungs, essentially breathing and keeping blood ﬂowing for patients who cannot do this on their own. Dr. Hackmann is also surgical director of lung transplantation at Keck Medicine and one of the most experienced physicians in Southern California in using ECMO on adults. Putting Melanie on ECMO was the only way to keep her alive long enough to let Dr. Matthews administer the drugs and let them do their job.
Neither component of Melanie’s treatment is widely available in Southern California. According to Dr. Matthews, most doctors rarely see patients with blood clots the size of Melanie’s and so most don’t have the technical expertise to dissolve them.
“Because a situation like this is so unusual, this procedure is not commonly employed outside of major medical centers,” he says.
Likewise, there are few area hospitals that have ECMO machines. Dr. Hackmann adds that Keck Medicine has the largest program in Los Angeles and one of the largest on the West Coast for using ECMO.
Working in Concert
Using ECMO bought Melanie critical time for the medication to rid her lungs of the clots that put her life in peril. While most patients who need help from ECMO are transplant patients, Dr. Hackmann says that she often collaborates with doctors from other departments who need help from this life-saving device.
This type of cross-disciplinary eﬀort is another beneﬁt for patients at Keck Medicine. “There are a lot of opportunities to work in concert,” says Dr. Matthews. “The closeness of these relationships between disciplines, because we are in a collaborative environment, is really beneﬁcial to our patients.”
The teamwork of the physicians from Keck Medicine saved her life, but Melanie had a way to go before she was herself again. After nearly two weeks in the intensive care unit, a team of physical therapists helped her rebuild her strength in her arms and get back on her feet. “I had no strength at all for a while and had to work up to things like brushing my teeth by myself,” she recalls.
Finally, the time came to head home. After leaving Keck Hospital, Melanie remained on blood thinners for about a year, which meant she had to use extra caution not to injure herself in any way. Now, however, Melanie’s health crisis is squarely in the past. She is completely free of blood clots and has been weaned oﬀ the blood thinners. She has seen Dr. Matthews every six months for follow-ups, and he has given her a clean bill of health.
“I am so super blessed and so much more than grateful that I ended up with Dr. Matthews and the whole Keck Medicine team,” she says. “Without them, I wouldn’t be here and I wouldn’t be thinking about my future. They saved my life.”
Learn more at: cvti.keckmedicine.org
By Hope Hamashige