In a first attempt ever for the Commonwealth’s public hospital, physicians performed a lifesaving heart procedure: they were able to insert a device called a transvenous pacemaker in a patient who is awaiting transfer off island for the placement of a permanent pacemaker.
According to information disclosed by the Commonwealth Healthcare Corp. over the weekend, the patient developed a condition known as a third-degree heart block in which the natural pacemaker for the heart no longer works and the heart rate slows to life-threatening levels.
Due to “logistical issues,” the patient was not going to be able to travel anywhere any time soon.
CHCC contacted the Medical Referral Office, which has relationships with several hospitals in the Philippines and in Guam. MRO’s Ron Sablan contacted CHCC’s partners at the Medical City and at Asian Hospital.
According to CHCC, both hospitals went to work in providing CHCC with a transvenous pacemaker for the patient so that CHCC could stabilize and transfer the patient when the “logistical issues” were resolved.
“Both hospitals came through for us but the Medical City came through just before Asian Hospital and arranged to send us the pacemaker catheter and a generator, which enabled us to perform this lifesaving procedure for this patient,” CHCC said.
Sablan said both hospitals were more than happy to help out and wasted no time in responding to their request.
“The partnerships that we have established will make collaborative efforts such as this possible in the future, which will result in lives saved, improved delivery of health care to our citizens, and a reduction in costs to the CNMI government overall by allowing more judicious and efficient use of our resources,” he said.
Sablan said that Medical Referral often face time sensitive issues in getting appropriate care for CHCC patients and arrangements like this gives them another dimension to the spectrum of care that they are able to provide for the CNMI.
“We are always looking to improve our ability to respond to the needs of our patients,” he said.
CHCC said that in the past, the only option available at the public hospital for treatment was temporary pacing, which means placing pads on the chest and back and delivering electrical shocks 60 to 80 times per minute.
“As one would imagine, this is a very uncomfortable proposition and requires the patient to be sedated to the point of unconsciousness and remain that way for the duration of the pacing, which goes on until the patient can be airlifted to another facility for implantation of a permanent pacemaker to take over the damaged heart,” CHCC’s Dr. John Doyle said.
Doyle said that beside the discomfort, there is an inherent danger in sedating someone for so long and requiring a ventilator and breathing tube during the sedation.
Doyle also said that during the procedure, a thin catheter with a wire is placed in one of the large veins in the neck or chest and advanced into the right ventricle of the heart.
“It is then hooked up to a Pulse Generator, which delivers a much smaller and undetectable shock to the heart muscle and causes it to contract at whatever rate is set on the generator,” he said.
CHCC’s chief executive officer Esther Muña said the process was an exciting development for the hospital and for patients and that life technologies such as the procedure performed can mean the difference between surviving and dying.
“These are changes we are striving for at CHCC in order to provide the best care that we can for the citizens of the CNMI,” Muña said.
“We have been steadily increasing the services that we can provide locally that address the specific health needs of our people,” she added.
Muña said they are now doing cardiac testing—which in the past was referred off island at great expense and inconvenience for CHCC’s patients—and this has allowed CHCC to more accurately determine what the patient needs and expedites the delivery of appropriate care.
Despite CHCC’s budgetary challenges, the hospital still looks for innovative ways to improve health care delivery and to find areas where they can effectively change the outcomes in particularly challenging cases.
“This case is just one more example of our providers and our governmental agencies and collaborating hospitals working together to provide solutions to difficult problems,” Muña said.
She said the new relationships with their partner hospitals through Medical Referral will help CHCC have devices available for use in emergency situations in the CNMI.
“This will go a long way toward taking us to the next level in providing for the needs of our patients at CHCC,” she said.