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Download Summer 2017 A PUBLICATION OF VCU HEALTH The Beat PAULEY HEART CENTER S U M M E R — 2 0 1 7 Partners in Life ARCTIC Medical Director Dr. Mary Ann Peberdy and her husband, Dr. Joseph Ornato, have created one of the world’s most renowned cardiac resuscitation programs. The pair have been at the forefront of clinical care and research in cardiac arrest for decades. Continued JOSEPH ORNATO, M.D., AND MARY ANN PEBERDY, M.D., WORKING TOGETHER ON THE ARCTIC PROGRAM, WHICH CARES FOR ABOUT 90 PATIENTS EACH YEAR. With the recent arrival of the Weil Advanced Resuscitation, Cooling Therapeutics, else in somewhat of a calm manner, despite Institute, VCU is poised to also and Intensive Care (ARCTIC) program for post- the precariousness of the situation,” said become a basic and translational cardiac arrest care. Peberdy and her husband, Hershberger. research powerhouse in this field. Joseph Ornato, M.D., chairman of the VCU Peberdy, the C. Kenneth Wright Professor Emergency Department, began cooling of of Cardiology, created the ARCTIC program, “That day is a total blank in my memory. patients at VCU in 2004, shortly after “new one of the first of its kind in the country, What I’ve been told is that I had been on an data became available that demonstrated that in 2004. The program is multi-tiered, with elliptical machine, and I left that and went to if you lower the body temperature you can components including a continuum of a stationary bicycle. At that point, I blacked improve survival and neurological outcomes clinical care, research, community training in out and fell off the bicycle,” recalled Bob in patients that have had cardiac arrest,” CPR, and coordination with a highly trained Hershberger, 70, a U.S. Air Force veteran said Peberdy. network of EMS’s and partner hospitals. and retired executive vice-president of the Following successful heart resuscitation “She is a master physician and truly Williamsburg Chamber and Tourism Alliance. after cardiac arrest, the patient often remains devoted to advancing the science for the in a coma from lack care of our patients,” said Vigneshwar “The work Dr. Peberdy and Dr. Ornato did with the of blood flow to Kasirajan, M.D., cardiothoracic surgeon and ARCTIC Program was pioneering. They did this the brain during the chair of the department of surgery. at a time when no one was really thinking about cardiac arrest. The In 1974, on the first day of his cardiology cardiac arrest and post-sequalae to the brain. body undergoes a fellowship at New York Hospital—Cornell Much of the work was done quietly and without rapidly escalating Medical Center, Ornato was assigned much fanfare. Now, this is the cutting edge of inflammatory to oversee and hone the training of the cardiovascular medicine.” response that can paramedics. “At that time, it was the only — Vigneshwar Kasirajan, M.D. further jeopardize 24/7 paramedic program in all of New York survival and City,” he recalled. Hershberger has pieced together neurological outcomes. To prevent and Although he knew little about the work, some of the details from April 7 when he reverse this damage, ARCTIC patients he began joining the paramedics on calls suffered a cardiac arrest—an often-fatal like Hershberger undergo therapeutic during slow times in cardiology. “Within condition when the heart suddenly stops temperature management with an a couple of months, we actually had our beating effectively—while working out intravascular cooling device, which chills first survival from cardiac arrest…which in at a local health club. Attendants at the their body temperature to 92 degrees for 1974 was virtually unheard of. If your heart club rushed to his aid and called a rescue 24 hours, then gradually returns the body stopped out of hospital, you were going squad. Paramedics shocked his heart with temperature to normal. to die,” he recalled. A few days after she a defibrillator and brought him to Sentara For Hershberger’s wife, Margaret, and awakened in the coronary care unit, his Williamsburg Regional Medical Center, other family members who gathered at VCU elderly patient—who was looking forward to where he was stabilized and then loaded to wait and worry, it was a lot to process: the birth of her first grandchild—expressed onto a critical care helicopter for transport. The death of a loved one, resuscitation, then her gratitude to Ornato with a kiss on his At VCU Medical Center, he was placed a coma. But Peberdy helped them through it. cheek. “I remember thinking, `I’ve been under the care of Mary Ann Peberdy, M.D., a “They were impressed by her. She was kissed by a dead person’. That moment cardiologist and the medical director of the very calm, which helped to keep everybody changed my career.” Today, through his work as a cardiologist the AHA got Congress to pass the Cardiac About the Doctors: and Emergency Medicine specialist, Ornato Arrest Survival Act of 2006,” said Ornato. still works closely with early responders, Soon after the study was published and who play a key part in the “chain of survival” the Act was passed, all federal buildings in the Mary Ann Peberdy, M.D., and necessary for cardiac arrest patients to country were required by law to have AEDs in Joseph Ornato, M.D., have survive. In addition to his work at VCU, he public places, and all airlines and airports now devoted a significant part of is the medical director of the Richmond have AEDs and personnel trained to use them. their careers to cardiac arrest Ambulance Authority, Richmond Fire & The ARCTIC program underwent several patients. Triple board-certified in EMS, and Henrico County Division of Fire. big changes in 2008. The first was that Cardiology, Internal Medicine, and He ensures all are kept up-to-date on VCU’s VCU began serving as a regional hub to Emergency Medicine, Ornato has ARCTIC program and cutting-edge science in other hospitals for its advanced post-arrest published over 400 papers in the resuscitation. therapies. The second was that the program’s field and recently was awarded attending physicians the prestigious American Heart Peberdy, the C. Kenneth Wright Professor of shifted their focus from Association National Clinical Cardiology, created the ARCTIC program, one cooling patients from the Research Award for his work. of the first of its kind in the country, in 2004. “outside in”—using cooling Peberdy is also triple boarded in blankets, ice bags and gel Internal Medicine, Cardiology, He and Peberdy also oversee the pads—to the “inside out.” The latter involves and Advanced Heart Failure and training of ARCTIC attending physicians, a endovascular cooling, which involves the use Transplant and has published component of the program that separates of a closed-circuit catheter that controls body over 200 articles. it from others in the small club of top-tier temperature internally. Both physicians have served cooling programs. The newer process allows for “targeted on the AHA national committees “We have five attending physicians who temperature management,” which includes for resuscitation science and are on call, 24/7, to help with the decision- an induction phase, in which the body is have been authors in the AHA making for the therapy,” he said. “We really cooled; a maintenance phase, in which the Guidelines for resuscitation tried to have a small enough number so lowered temperature is maintained for about continuously since the 1980s. that we could ensure that every one of us 24 hours; and a rewarming phase, in which They are also founding is absolutely up-to-date on what the latest the body is returned gradually to its normal physicians of the AHA Get with science is showing as to the proper use and temperature. the Guidelines-Resuscitation selection of patients for this kind of cooling The process of caring for ARCTIC Program, which is the world’s therapy.” patients in the Coronary ICU is dynamic. largest repository of performance The volunteer group includes Ornato “Care is minute-to-minute and hour-to-hour. improvement and research data and Peberdy; Antonio Abbate, M.D., Ph.D., It’s constant evaluation and re-evaluation,” for in-hospital cardiac arrest. James Roberts Professor of Cardiology said Michelle Gossip, BSN, ARCTIC care and vice-chair of the Division of Cardiology; coordinator. Stephen Miller, D.O., assistant professor of Nurses play a key role, she said. “It is Learn more… Emergency Medicine; and Harinder Dhindsa, the nurse who sees subtle changes in our M.D., chair of the Division of EMS. patient population and, working with our “Dr. Ornato is one of the leading physician staff, provides ongoing emotional View the VCU ARCTIC Program on international experts in cardiac resuscitation. support for patients and families.” a PBS NOVA program that aired He is not satisfied with the current state of Unlike many other programs, continuous on January 26, 2011. To view it, the art, and he and his research and clinical brain wave monitoring is performed and visit PBS.org/wgbh/nova/body/ partner, Dr. Mimi Peberdy, are developing there is a strong focus on ventilation, can-we-live-forever.html (the new tools for treating and preventing cardiac hemodynamic, and metabolic parameters segment starts around the 47-minute arrest,” said Kenneth Ellenbogen, M.D., chair to improve outcomes. The ARCTIC program mark). of the Division of Cardiology. was also the first in the country to perform One of Ornato’s most important detailed neuro-cognitive testing in survivors contributions was serving as principal to identify more subtle, persistent areas of Hear the story of 16-year-old investigator of the Public-Access Defibrillation brain injury and begin early rehabilitation ARCTIC survivor Ellie Whelan at study, which was funded by the NIH, the AHA, treatment in these patients.
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