London hospital uses ‘James Bond medicine’ to tackle rare heart condition

James Bond medicine and cutting edge technology are used by world-class NHS doctors to save lives of patients whose hearts have stopped beating due to rare and sometimes fatal heart conditions.
The Royal Brompton and Harefield NHS Trust in London has started sending specialist medical personnel to hospitals across England and Wales in order to save patients who might otherwise die.

In a desperate attempt to save people suffering from cardiogenic shock (CGS), they are brought to Royal Brompton Hospital, one of Britain's leading centres for heart medicine excellence.

Only a handful of hospitals can offer intensive care to patients, which includes extracorporeal membrane oxygenation, in which blood is taken from the patient and oxygenated. This is used to aid in breathing.

The trusts shock program has doctors, surgeons, and intensive care specialists who discuss and offer advice about how to treat CGS patients. This condition is a frequent problem in hospitals across the UK and many have requested urgent assistance. CGS has a high death rate, with only about half of those who were diagnosed in recent years dying.

This is a potentially life-threatening condition in which the patient's heart stops pumping enough blood around their body. If left untreated, it can lead to multiorgan failure or death.

Most cases are caused by a side effect of severe heart attacks, which mainly affect older people. It can also occur in younger people due to a clot on their lungs, abnormal heart rhythm, birth or infection of the heart muscle.

It is the result of another medical emergency and extreme heart failure. It's similar to having a cardiac arrest but in slow motion, explained Prof Susanna Price who is the programme leader.

Professor Martin Cowie is a consultant cardioologist and the lead on heart failure programmes. He said: While this may seem like the James Bond 007 ending of medicine reaching into other hospital to save them, it's actually about the NHS making certain that the patients who might be able to benefit will, wherever and whenever they are.

No matter what reason your heart has stopped beating, we don't care. We are here to save you.

After a 17-year old girl died from CGS in a remote area of Wales, the hospital that treated her mistakenly diagnosed her with sepsis, the trust established the UK's first CGS service. This was extremely distressing as she had a potentially fatal condition. Price said that Price and I realized that there wasn't a national program to treat CGS. We decided to create our own shock program.

Riccardo Mura, a staff nurse, on a ward where a patient is receiving care at Royal Brompton. Photograph by David Levene/The Guardian

The trust organizes an emergency virtual multidisciplinary team, even if it is not in the night, as soon as another hospital has notified them about a case. The team either advises the doctors on the best way to handle the patient or sends a blue-light ambulance for them to pick them up. Although they have a better chance of survival, not all patients survive in the London hospital.

600 patients are treated annually by The Brompton for a serious cardiac condition. 60 to 70 of these patients end up in CGS.

Survival is dependent on the ECMO machine, a 18-inch tall metallic contraption. It is used by approximately 20-30 patients per year and puts them in a coma. This form of life support is the best in the NHS, higher than a mechanical ventilator. Others are placed on a ventricular assistance device. The blood is extracted from the tubes and then returned to the machine.

ECMO is not a treatment. The ECMO machine is a time-saver. Price stated that ECMO supports the body while we treat the underlying cause. She added that ECMO is a risky and invasive procedure, particularly for older patients who have suffered a heart attack.

Doctors in European hospitals now regularly call the Brompton to get advice due to the success of the shock programs. One British national has been rescued by the team in CGS from Spain.

They also perform a caesarean in a CGS-injured pregnant woman nine to ten times per year. All the mothers have survived so far.

Patients treated at the Brompton Hospital for CGS have seen their survival rates increase from 51% to 86% between 2018 and 2020-21, thanks to the shock program.

Price said, "It's very rewarding to give people back their lives." Price was reflecting on the dramatically decreased mortality. The patient is there, and you and your team can bring extraordinary expertise to the table and negotiate a way to survival that would not have been possible without them.