For heart attack survivor, luck played a role
Portable heart-lung machine and his stepfather’s quick thinking helped save New Britain man’s life
Gino Marcantonio has two things to be thankful for that helped save his life when he collapsed from a heart attack on Jan. 21 in his mother’s house.
One is technology: Hartford Hospital’s ECMO on the Go. The other he attributes to luck and his stepfather’s knowledge of CPR.
Without both, he wouldn’t be alive today.
His stepfather’s quick action kept Marcantonio alive until EMTs arrived. And ECMO gave him the time needed for medication to dissolve the clot that caused his heart attack.
Marcantonio, 41, of New Britain, is a dispatcher for Sack Energy.
“For me, a typical Sunday is when I wake up in the morning, I go to the gym first,” he said. “And that particular Sunday I went to my mother’s house afterwards. Her, myself and my stepfather, we have breakfast every Sunday.”
After breakfast, he felt chest pains and “I didn’t really feel that good,” he said. But he figured he had worked out too hard.
“So I went upstairs to just go rest for 10 minutes or so,” he said. “And apparently they heard me fall off the bed, and I hit my head against the closet door.” The next thing Marcantonio remembers is waking up in Hartford Hospital.
In the meantime, his stepfather, Rich Lagueux, a former military medic, began giving him CPR. His being at his mother’s house in Plainville was the lucky part. When EMTs arrived, he was sent to the Hospital of Central Connecticut in New Britain.
Ultimately, he said, he was given electric shocks and CPR about 26 times because he never flat-lined but his heart also never really revived.
The EMTs “gave him around five to six rounds of CPR,” according to Dr. Abhishek Jaiswal, associate director of the mechanical circulatory support program.
“And they in the process brought him to HOCC (Emergency Department). In HOCC ER, he continued to be in cardiac arrest,” he said. “Right away he will slide back into intermittent cardiac arrest and return of what we like to call a spontaneous circulation,” or the return of a sustained heart rhythm.
The ongoing CPR continued for an hour and 45 minutes as Marcantonio continued to lose blood pressure and needed CPR to have his
heart return to rhythm, Jaiswal said.
Meanwhile, Marcantonio had been given medication for a blood clot, which the doctors believed had caused his heart attack, a rare type called spontaneous coronary artery dissection, which usually occurs in women, Gluck said.
Jaiswal said SCAD is responsible for only 1% to 4% of all heart attacks but about a third of heart attacks in women younger than 50 and is the leading cause of pregnancy-associated heart attacks.
“The thought in retrospect is that he probably had some spontaneous artery dissection, not his fault, something that he couldn’t control,” said Dr. Jason Gluck, system director of Hartford HealthCare’s mechanical circulatory support program.
“And that probably caused a clot that blocked the artery. And then when the clot buster medicine was circulated over time, it cleared that clot,” he said. “And the dissection kind of healed itself.”
In order to give the medication the time it needed, it was decided to put Marcantonio on extracorporeal membrane oxygenation — ECMO — “which is a fancy way of saying providing the circulatory support by bypassing the lungs and the heart,” Gluck said.
The device, which became well known in the early days of the COVID-19 pandemic when it was used for severely ill patients, removes blood, oxygenates it and returns it to the body.
The Hospital of Central Connecticut doesn’t have an ECMO machine. But Gluck said the advantage of being part of Hartford HealthCare is that technology can be shared among all hospitals.
“The program that we use for this patient is called ECMO on the Go,” Gluck said. “ECMO is a heart-lung machine. That’s essentially what it is. It’s an artificial heart and lung that we can bring in a suitcase.”
Since not every hospital has ECMO, “we take the heart-lung machine, and our ECMO team, our doctor, our perfusionist and Life Star, and we take that technology to the patient’s bedside.”
“ECMO is a machine that essentially drains blood from the body,” Gluck said. “The blood that gets sucked out of the body, it goes to a pump. Then from the pump, it goes to an oxygenator, which is like a fish lung. That adds oxygen, removes carbon dioxide, just like your lung does when you breathe.”
The blood is then added back to the body. While ECMO was used during COVID to assist the lungs for patients who had respiratory issues, in this case it was used to assist the heart. ECMO on the Go is used 15 to 30 times a year at Hartford HealthCare, he said.
They flew the ECMO to the Hospital of Central Connecticut, hooked Marcantonio up to it, “so that they could then move to Hartford Hospital for definitive care,” Gluck said.
“Our goal for the program is to be from phone call to on scene within 90 minutes, which is very fast for a team to respond. And that’s what happened here,” he said. “Without this technology, he would have died at HOCC because the heart wasn’t strong enough to maintain for any meaningful period of time,” he said.
“While at HOCC, they gave a clotbuster medicine, thrombolytic, and they think that there was a clot in the big artery down the front of the heart, and that clot-buster medicine needed more time to work,” Gluck said. “So by being on this heart-lung machine, it gave that patient the time they needed for that clot-buster medicine to work.
“So actually, by the time they got to the cath lab here, which was several hours later, there was actually nothing to really do because the medicine had the time it needed to work and the heart then recovered,” he said. That was less than three hours after Marcantonio’s attack.
Marcantonio then needed to stay at Hartford Hospital while the broken ribs he suffered while undergoing CPR were set.
Jaiswal said all the ECMO wouldn’t have had a chance to extend Marcantonio’s life if his stepfather hadn’t been on the scene when he suffered his heart attack.
“One of the things which helps in the community if somebody has a cardiac arrest is what we call early and effective CPR, which he did receive … from his stepdad and then from EMS and then continued on in HOCC ER,” he said. “So that was perhaps one of the most vital things which helped him.”
Gluck said Connecticut is one of the worst states for people to know and to use CPR.
“People don’t do it. People aren’t trained,” he said. “Some states have it in every single elementary school and middle school as part of their curriculum. We don’t in Connecticut. … So if there’s one thing that I could stress to the people that read this article, it’s please go take a CPR course and learn how to use it. Because that saved this guy’s life. That allowed us to do what we can do.”
He said starting chest compressions immediately can mean going from 10% chance of having “meaningful neurologic recovery” to 15% to 20% if CPR is begun immediately.
“If everything hadn’t happened exactly the way it did when it did, I wouldn’t still be here,” Marcantonio said. “If it wasn’t for my stepfather, first and foremost … starting it properly right then and there, and then the EMTs doing what they did, nothing would have worked out the way that it did.
“I don’t know if I would still be here at all, or if I was here would my cognitive functions be anywhere near what they are?” he said.
He said Legueux is “a very quiet and reserved individual, so he basically doesn’t even really acknowledge that what he did had the effect that it had.”
Marcantonio was a little concerned that there was nothing he could do in terms of diet and exercise to prevent another heart attack like the one he experienced. He does go to the gym five days a week as it is.
“I also don’t want to just live in fear moving forward of, oh gosh, what if this happens again, and just sit around and not go back to the gym or not push myself through the physical therapy that I have to do,” he said.
“I do want to set goals for myself physically, mentally, as I move forward from this and not just live in fear that it’s going to happen again, especially when I know that there’s basically nothing I can do to prevent it from happening again,” he said.