Our ECMO physicians, Dr. Melo and Dr. Thangudu, help McMullen Co. Commissioner survive five cardiac arrests

SAN ANTONIO, TX ― It is extremely fortunate to survive a cardiac arrest, but even more of a miracle to survive five of them in the same day. Hilario “Larry” Garcia, McMullen County Commissioner and Director of Maintenance and Transportation at McMullen County ISD, did just that last month.

“He’s doing well, all things considered,” said his sister, Gloria Garcia. “He definitely went through some life-altering moments and events, but he’s looking forward to being up and running again.”

In late April, Larry was treated for an abscess at Methodist Hospital | Metropolitan in San Antonio. Due to an infection, his wound was carefully scanned throughout the entire healing process. During a routine scan, his care team discovered a small tumor developing on his left kidney which a biopsy confirmed to be malignant. On May 9 Larry had an ablation, a minimally invasive technique commonly used in the treatment of tumors of the liver, kidney, bone and lung.

Larry was initially scheduled for discharge on May 11. However, that did not happen.

“Timing is everything,” said Gloria. “His nephew was late in picking him up, and we believe it was for a reason.”

Early that morning, Larry was up talking to family members on the phone. As he waited for his nephew to pick him up, Larry was taking one last walk around the nurse’s station when his breathing suddenly became challenging and he began to feel dizzy. He was given oxygen, but within seconds, Larry went into cardiac arrest. His care team immediately began resuscitative efforts. Over an hour and a half, Larry went into cardiopulmonary arrest five times.

Surviving Cardiac Arrest, PERT care

Larry suffered a pulmonary embolism (PE), a blood clot that wedges into an artery in the lungs. These blood clots most commonly come from the deep veins of the legs, and in many cases, multiple clots are involved. The portions of lung served by each blocked artery are restricted of blood, making it more difficult for the lungs to provide oxygen to the rest of the body. Larry was given TPA, a strong clot-dissolving medicine to alleviate the clot, but he continued to get worse.

In an effort to increase response times and reduce mortality with someone experiencing a PE, Methodist Hospital established a pulmonary embolism response team (PERT) to target and treat high-risk massive PE by effectively engaging multiple specialists to determine the best course of treatment. The PERT also coordinates rapid response care for patients with life-threatening conditions. Fortunately for Larry, this level of expert response saved his life.

Larry’s physician had to assess his condition to see if he qualified for a PERT. If he remained stable during his transfer to Methodist Hospital, he would qualify and stand a chance of living.

“We’re big on putting it in God’s hands. We believe in the power of prayer, so we prayed all night long while we waited,” said Gloria.

PERT critical care specialists determined ECMO was Larry’s only chance at survival as his heart was unable to function on its own.

Larry was placed on veno-arterial extracorporeal membrane oxygenation (V-A ECMO), a form of cardiopulmonary lifesupport where blood is drained from the vascular system, circulated outside the body by a mechanical pump and then reinfused into the circulation. He was on massive life support and barely able to maintain normal blood pressure. Significant clots in his lungs caused the right ventricle of his heart to fail. ECMO was able to relieve this pressure on his heart. Within 24 hours, Larry was off of his ventilator and all life support medications. Within 48 hours, he was removed from ECMO.

“Traditionally, these types of patients are too sick to treat,” commented Pavan Thangudu, MD, Intensivist at Methodist Hospital. “Larry’s story is a reflection of what [Methodist Hospital] is capable of achieving. This wasn’t someone we were expecting to survive, but the ideal medicine and expertise were in place to ensure a positive outcome for this patient.”

Recovery

Larry went home on May 21 and is doing well. He is attending his follow-up appointments as necessary and receiving therapy to regain his strength. He will meet with an oncologist from time to time. However, there is no need for chemo or radiation treatment as the tumor that was found on his kidney was ablated.

“He’s very blessed to be where he is today and is super thankful to be a part of such a supportive community like McMullen County,” she said. “We’re thankful to Methodist Hospital for taking such good care of him.”

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