New pumps provide safety net for patients

Most patients will never need one of Kalispell Regional Medical Center's three new intra-aortic balloon pumps.

The sickest heart patients may never know that the state-of-the-art pumps provided a critical life-support bridge.

But Dr. William Highfill, an invasive cardiologist, knows the subtle difference this equipment makes for a patient entering the medical center's heart program.

About three years ago, Kalispell Regional affiliated with the International Heart Institute in Missoula to provide cardiac surgery in the Flathead. Three surgeons serve both programs, providing regional cardiovascular surgical services.

"We (invasive cardiologists) do stents and angioplasty and the surgeons do bypasses and valve replacements," Highfill said.

The program's new intra-aortic balloon pumps provide a safety net for high-risk heart patients. Highfill said these are the sickest patients, not those who leave the hospital in five or six days.

"But these days, there are more older and sicker, high-risk patients," he said. "There are a lot more co-morbidity patients."

Highfill gave the example of a patient with co-morbidity as one with heart problems who is 75 with diabetes and bad kidneys.

"The bottom line is the more you have wrong, the more likely there could be problems," he said.

That's where the pump proves its worth.

Highfill described the device as functioning like part of an artificial heart. It assists heart function when a patient's biological pump falters.

"We would use this when someone has had a bad heart attack and is in shock," Highfill said. "Or when someone can't come off support after a bypass."

The cardiologist said that the basic balloon pump has been around for 30 years or more. But Kalispell Regional's Arrow AutoCAT 2 WAVE pumps have new, patented technology.

"It has almost real-time monitoring," Highfill said. "It reacts immediately to atrial fibrillation."

With other pumps on the market, cardiac support is lost if a patient develops arrhythmias (irregular heart beats). The Arrow pump instantly adjusts no matter how erratic the heartbeat becomes.

The equipment includes a polyethylene balloon mounted on a catheter. Invasive cardiologists like Highfill install the device by threading the catheter through the femoral artery of the leg into the aorta, the main trunk of the arterial system.

Once in place, the pump augments the heart by inflating the balloon as the heart valves open to accept blood and deflating as the valves close to expel blood.

"It unloads the heart" of blood, Highfill said. "It's for patients who have poor cardiac output."

He said the pump makes a dramatic difference for people who come in with pain from two or three vessels more than 95 percent blocked.

"We can stabilize the patient and unload the heart [with the pump] and take care of the case the next morning as elective rather than emergency surgery," Highfill said.

He said Kalispell Regional Medical Center's heart program is unique because it now has three intra-aortic balloon pumps of the same kind and vintage.

Most community hospitals own a mix of old and newer pumps made by different companies. As a result, nurses and technicians need to know how to operate and maintain several different devices.

"Nurses might see one of these in ICU in an entire year," Highfill said. "That's an undesirable situation."

When the cardiologist joined the heart program a year and a half ago, he advocated buying several pumps at the same time to have the same equipment systemwide. It also allowed the hospital to get the best possible price.

Now, Kalispell Regional Medical Center has identical equipment in the operating room, cath lab and intensive-care unit.

"It's the ideal situation," Highfill said. "They are almost foolproof - they are really so automatic."

With the old pumps, a nurse was required to stay by the patient's bedside to monitor the heart rate and constantly adjust the cycle rate to match.

"It was very tricky using these in unstable patients," he said. "You had to know when and how to use them."

With the new pumps, Highfill said the learning curve is much shorter. He said the new generation of nurses will never have to learn "how to tweak" these pumps to keep them operating.

Along with the improvements in technology, the new pumps are lighter and more portable. Highfill said that comes into play when the surgeons decide to send a complex case to Missoula or farther.

"The old pumps were much heavier - you needed a fixed-wing to handle the weight," he said. "These can go on a helicopter."

The purchase was made possible through a gift from the Northwest Healthcare Foundation.

At just under $60,000 each, the pumps represent the largest gift to date from the foundation to the hospital. Other equipment provided has included a night-vision training course, a defibrillator monitor pacer and a motorized stretcher.

Hospital spokesman Jim Oliverson said each of these purchases represents an item the staff requested that the hospital couldn't handle in its annual equipment budget.

Bob Marsenich, acting foundation director, has more information at 751-6767 about the variety of programs available through the foundation to make donations.

Highfill said the pumps helped the heart program move toward its goal of a zero-mortality heart-surgery program.

"We've had a very good year so far," he said. "We haven't had an operational death for a year and a half."

Reporter Candace Chase may be reached at 758-4436 or by e-mail at cchase@dailyinterlake.com.