One Year Later: Former STEMI Heart Attack Patient Returns to Help CIC Mark First Year of Service Saving Lives on the Mid-Shore
On March 29, last year, Carl Langkammerer, 59, of Preston was working at the Oxford Boatyard when he decided he needed some different tools from a nearby shed. What happened next changed his life, and without the lifesaving Cardiac Catheterization Laboratory team and procedures provided at University of Maryland Shore Medical Center at Easton, Langkammerer, who was 58 at the time, knows he wouldn’t have survived.
An avid sailor and log canoe racer, Langkammerer believed he was getting enough exercise through those activities, as well as through the hands-on nature of his job as a shipwright. “I thought I was in good shape,” Langkammerer said. “Until I was 43, I was even an avid swimmer.”
Langkammerer was working on a boat that had been under cover, climbing up and down a ladder before heading for the tool shed. He was about 20 feet from the shed door when he remembers saying out loud that he was “going out” and reaching for the ground.
“I never remember touching the ground, but I obviously went down and I was out. I was out for quite a while,” Langkammerer said. Langkammerer said if it weren’t for his co-workers, the EMTs on the ambulance and the guys at the Oxford Volunteer Fire Department, he may not have made it to the hospital. What came next was “bystander CPR” and two AED shocks – the first of which brought him back and shocked his heart into a temporary, life-sustaining rhythm. From there, he remembers telling the EMTs they had the wrong guy.
“I’ll never forget, ‘bam,’ the paddles bringing me back to life,” Langkammerer said. “I told the paramedics, ‘You’ve got the wrong guy. I’m not having a heart attack. It’s not happening. Boy, are your faces going to be red.’”
At UM Shore Medical Center in Easton, cardiac interventionist Dr. Gabriel Sardi worked quickly to perform emergent percutaneous coronary intervention (PCI, formerly referred to as angioplasty with stent). PCI is a minimally invasive procedure using a catheter to place a stent that opens up blood vessels in the heart that have been narrowed by plaque buildup. Dr. Sardi placed three stents in Langkammerer’s coronary artery to get the blood flowing into his heart. Langkammerer remembers feeling instant relief.
Following his transport by EMS to the hospital Emergency Department, the PCI procedure took just 37 minutes – 53 minutes under the national target time of 90 minutes, according to Gary Jones, UM Shore Regional Health’s regional director of Cardiovascular Services. Easton’s Cardiac Intervention Center is on record as achieving target times of under 60 minutes, 95 percent of the time.
The life-saving PCI procedure Langkammerer underwent wasn’t available at the Easton hospital until February 2018, when the hospital was designated as a Cardiac Intervention Center (CIC) by the Maryland Institute for Emergency Medical Services Systems (MIEMSS).
“Achieving that designation required a very exacting application, which is understandable because it’s pretty impactful when you decide you’re going to provide those services,” Jones said.
Before the CIC designation, Jones said, patients in the region experiencing STEMI heart attacks (ST-segment elevation myocardial infarction) were transferred to the closest Cardiac Intervention Center that offered treatments for this type of heart attack, which occurs in about 15 to 20 percent of all heart attack patients.
Many of this particular type of heart attack patients were transported, by ambulance or helicopter, to hospitals in Annapolis, Salisbury, Seaford, Delaware, or University of Maryland Medical Center in Baltimore. These transfer decisions were based on proximity to CIC level care, but also took into account traffic and other factors that could affect the survival of a patient during travel. Travel times alone pushed the boundaries of the desired target time of under 90 minutes, and optimally, within 60 minutes.
“The issue then was a delay in transport time, based purely on the travel distance required, traffic volume, road conditions and so on,” Jones said. “Under the best of circumstances, travel time is an issue. Even with safe transport, the impact was that the heart muscle was being deprived of oxygen during the travel time.”
Jones explains that the patient’s heart would have undergone additional stress through deprived oxygen and blood flow that could lead to heart muscle damage and ultimately, to complications such as congestive heart failure, which means the heart doesn’t pump as effectively as it should. That’s why the emphasis is placed on getting narrowed arteries opened up as soon as possible.
“Time is muscle,” Jones said. “That’s the bottom line as to why you provide these services in a qualified center as soon as possible to reduce the potential for this type of heart muscle damage to occur.” He also emphasized that without a strong partnership with local emergency medical personnel in the field, this groundbreaking support system for Mid-Shore residents wouldn’t be possible in emergency situations.
Jones has a long history in helping to bring advancements in cardiac care to Shore Regional Health. For the past few decades, he’s been involved in the evolution of the Cardiac Intervention Center, from its inception as a diagnostic-only catheterization lab in 1991 to the construction of the new Cardiac Intervention Center and its official CIC designation in late February 2018.
Since the designation , the CIC team has received 183 “call team activations” – meaning a patient experiencing a possible STEMI heart attack is arriving at the hospital. Of those cases, 86 underwent the emergency PCI procedure, which is practically double the anticipated annualized volume, which had been projected to be about 50 each year.
Noting that the CIC team also has performed just under 300 elective (non-emergency) PCI treatments since March 2017, Jones added, “What’s unique about our program, as recognized by the MIEMSS surveyors, is that we’re providing services to three acute care hospitals and four emergency departments,” Jones said.
The UM Shore Regional Health Cardiac Cath Lab team will continue to refine the program to ensure the Mid-Shore is getting access to the quality care its residents have come to expect from UM Shore Regional Health. The team includes 18 nurses and technologists (full- and part-time) who staff three call teams of four people each. When called, they must be able to respond within 30 minutes to the hospital. “The CIC team members make considerable personal sacrifices to make sure they deliver this quality, lifesaving care to the Mid Shore, 24 hours a day, 365 days a year. This also impacts the two interventional cardiologists, Dr. Jeffrey Etherton, and Dr. Gabriel Sardi, who must also be available,” Jones said.
Dr. Etherton is the medical director of the Cardiac Intervention Center. A native of St. Michaels, Etherton was in private practice in Salisbury prior to joining University of Maryland Community Medical Group-Cardiology in 2016.
Once the Cardiology program at Shore Regional Health received funds to build a second Cardiac Catheterization Lab and interventional center, Etherton led a team to visit and evaluate several facilities in Maryland, Virginia and Delaware. We took the best aspects of these established centers and built ours on that basis,” he said. “It’s the best I’ve worked in during my 30 years in practice.”
Etherton said having a CIC in the heart of a relatively rural area is not the norm.
“Having a Cardiovascular Intervention Center at the community’s disposal, and particularly providing primary PCI treatments, is a rare gift to a rural area,” Etherton said. “Many patients would have to travel an hour or more to have the procedure, and when every minute counts and survival is counting on those moments, sometimes that’s not an option. UM Shore Regional Health providing this for the Mid-Shore sets us apart from similar rural regions.”
“Experience nationally has shown that with advances in the effective medical management of heart disease, and early diagnosis and treatment options to include access to PCI, there has been an overall decrease in open heart surgery,” Jones said.
Etherton said the eventual goal is to add a third Lab and to recruit a third cardiac intervention specialist to work with him and Sardi to be able to provide even more services in the future.
As for Langkammerer, he’s feeling better today than he has in a long time and is “hitting cardio rehab” as hard as he can. He’s followed doctor’s orders and says that Sardi’s advice has led him to make several changes in his life in order to maintain his heart health. This spring, he’ll be back on the water doing the things he loves, including long-distance swimming, sailing, and log canoe racing, and he hopes to “pay it back” by teaching Sardi to sail.
He said he knows he wouldn’t be here if it weren’t for the Cardiac Cath Lab at Easton, bystander CPR, and top-notch EMS Paramedic services.
“As I understand it, having not one but three stents put in, in such a short period of time, is one of the things that saved my life,” Langkammerer said. “I was in recovery in less than an hour after I had the heart attack. I felt instantly better. I am confident that I wouldn’t have survived a trip to Annapolis or Salisbury.”
“The people of the Mid-Shore are wonderful and their lives are precious,” Etherton said. “It has been a privilege and an honor for Dr. Sardi and me to save the lives of dozens of patients here who were suffering from devastating heart attacks. We are dedicated to continue this program and make it even better. It couldn’t have happened without the EMS providers, the cardiologists we work with, the hospital directors and leadership, the many nurses and technicians, and our community’s support.”