Spring 2020

Protocol overhaul

Demetri Yannopoulos, M.D., discusses the future of cardiac arrest care in the Twin Cities

For almost 20 years, Demetri Yannopoulos, M.D., has found hope in one of medicine’s most dire situations: treating sudden cardiac arrest, a condition that typically kills nine out of 10 victims. Yannopoulos, an M Health Fairview interventional cardiologist and University of Minnesota Medical School professor of medicine, has collaborated with Twin Cities emergency medical directors to overhaul resuscitation protocols, resulting in survival rates near 40% for people who experience cardiac arrest away from the hospital.

Demetri Yannopoulos, M.D.

How are heart attacks and cardiac arrest different?

Cardiac arrest can be caused by a heart attack, but they are not the same thing. Heart attacks occur when blood flow through one of the heart’s arteries is blocked. Cardiac arrest is a much more serious condition: It happens when the heart stops beating, which results in the loss of blood flow throughout the entire body.

How do you treat cardiac arrest?

CPR can keep the person alive, but it only works for 30 minutes or so. We’ve found that the initiation of ECMO [extracorporeal membrane oxygenation] can help. It buys us more time to figure out why the cardiac arrest happened and how we can treat it.

The ECMO machine gives us a window to bring people back who might otherwise die. We’ve collaborated with EMS teams in Minneapolis and St. Paul, encouraging them to bring cardiac arrest patients to us at M Health Fairview University of Minnesota Medical Center as quickly as possible so we can begin ECMO.

How will the new mobile emergency department help these patients?

The truck is equipped with ECMO capabilities, which means the procedure doesn’t have to happen in specialized hospitals only. If you can decentralize this procedure and bring it to people where they are, even in rural areas outside the Twin Cities, we can save more lives. (See inside the mobile emergency department.)

How did the mobile emergency department get from idea to reality?

Through the imagination of many, many people. Probably 1,000 people came together to make this happen. The Leona M. and Harry B. Helmsley Charitable Trust was inspired by the idea and gave us the support we needed. We worked with other health care systems, pooling our resources, sharing our expertise, and, importantly, not competing against each other. We should not be competing when it comes to life-or-death situations like cardiac arrest. This is for a higher value and for the public good.

Time lost is brain lost

When the heart stops beating during cardiac arrest, the brain is starved of oxygen, and neurons start to die. This leads to irreversible brain damage, even if the person survives.

This scan shows the brain of a person who was resuscitated after cardiac arrest. The blue areas in the middle are damaged regions of the brain first affected by the absence of oxygen.

This is why quick intervention is so important. The sooner the blood starts flowing again, the better off the person will be. One way to do that is through extracorporeal membrane oxygenation, or ECMO, when a machine takes over for a person’s heart and lungs and restores blood flow throughout the body and into the brain.

Demetri Yannopoulos, M.D., has spent his career exploring how ECMO can be used more widely to help people experiencing cardiac arrest not only survive, but potentially avoid severe brain damage.