On November 27, 2018 our new book called Hope Rising: How the Science of HOPE Can Change Your Life will be released by Morgan James Publishing.  We have sold more than 2,000 advance copies from the publisher but look forward to the book getting to bookstores across the country in just one week!

Here is a short section from the first chapter:

On Thursday, November 30, 2017, Diane McGrogan was having chest pain. She was on her way to get her nails done for her company Christmas party on Saturday night. She called her sister, Joanne, and told her about the pain but said she would just pull over and wait until it passed.  Joanne told her to drive straight to the hospital and she would meet her there. Diane argued but eventually turned around and headed to Sharp Memorial Hospital in San Diego. On her way, she called her boyfriend, Ron, and he said he would meet her at the hospital, too. At the hospital, she parked her car and walked herself toward the ER.  As she approached the automatic doors, the pain was blinding.  She started to feel light-headed. The door got blurry. She sat down on a bench right outside the door of the ER. The pain shot down her right leg. She couldn’t make either leg move. Everything started going dark. Diane fell fast and hard off the bench.

 A nurse rushed out to her, found no heartbeat, and began cardiopulmonary resuscitation (CPR). They attempted manual CPR as they brought her lifeless body into the ER on a gurney.  Doctors, nurses, and technicians formed a team and worked to save her. Despite CPR, cardiac defibrillation (shocks) and medicines, Diane did not regain circulation. They soon hooked her up to a Lucas CPR machine, an automated chest compression device. The Lucas CPR provides consistent lifesaving, uninterrupted chest compressions to reduce the chances of neurological damage in patients who suffer sudden cardiac arrest.

 Dr. Joseph Bellezzo, the Chief of Emergency Medicine at Sharp Memorial Hospital was on duty that day. He saw the frantic team of doctors and nurses at work on her. In the life and death moments of the team checking vital signs, performing compressions to her chest, installing the Lucas CPR device, and yelling commands back and forth, Bellezzo determined that Diane’s heart was not capable of sustaining life. An EKG confirmed it, Diane had suffered a massive heart attack. The coronary cath-lab team was activated, but it would be 20 minutes before they would be ready for her. Bellezzo made the split-second decision to use a new procedure he had been perfecting (in conjunction with his colleague Dr. Zack Shinar) – the use of a heart-lung bypass machine -  to try to save the life of patients in cardiac arrest who would otherwise die in the ER. During the chaos of CPR, in a matter of minutes, Bellezzo made incisions in Diane’s femoral artery and vein - not in an operating room but in the Emergency Department. He next inserted wires into the blood vessels to clear a pathway to her heart, and then “cannulated” her (insertion of tubes). Cannulation allows blood to be drawn away from the failing heart, passing it through a machine that provides needed oxygen to the blood,  and returns the freshly oxygenated blood back to the body  – effectively providing total heart-lung bypass. ECMO kept her alive. It was a complete bypass of both her stopped heart and lungs, performed in a matter of minutes – life-support for the dead.

They would later find Diane had 95% blockage of her left anterior descending (LAD) artery. Considered the most important of three main coronary arteries to the heart, the LAD supplies over half of the heart muscle with blood.  When the left anterior descending artery is blocked, right at the beginning of the vessel, it is known as the “widowmaker” because many die without immediate medical intervention. The “widowmaker” caused Diane’s heart to suddenly stop beating and prevented the medical team from getting it started again. Diane, with 95% occlusion to her LAD, would have died on November 30, 2017 without ECMO and the life-giving team of highly skilled doctors, nurses, and staff.  Once on ECMO, Diane was rushed into surgery that first night, to clear the blockage, insert a stent (scaffolding to keep the blood vessel open), and get her heart pumping again on its own.  It would be four days on ECMO before her heart was able to recover and function without mechanical assistance.  Every day was filled with ongoing 24-hour support.  A small, elite group of highly trained nurses manage the ECMO program at Sharp Memorial Hospital and  are trained to monitor and care for these type of heart-lung bypass patients.

 Total heart-lung bypass is called veno-arterial extracorporeal membrane oxygenation (VA-ECMO). In adults, VA-ECMO is most often used to support open heart surgery patients who need prolonged cardiac support.  It is also commonly used as life-support in newborns born prematurely, or with serious birth defects, that require vital organ support. When ECMO was first developed and machines were created in the 1980’s, no one ever imagined that it would be used to resuscitate Emergency Department patients suffering massive cardiac arrest. But as Dr. Ian Malcolm said in Jurassic Park, “Life…finds a way.”

 On July 28, 2010, Drs. Bellezzo and Shinar were the first Emergency Physicians to successfully use VA-ECMO in the Emergency Department – and saved a cardiac patient who suffered a widowmaker. To date, Bellezzo and his team have used ED ECMO to save many patients who would have otherwise died from massive cardiac arrest. Sharp has become one of the leading VA-ECMO hospitals in the United States.  Bellezzo and Shinar, along Dr. Scott Weingart, now travel the world training other doctors in the procedure – helping them to save more and more cardiac patients who suffer refractory cardiac arrest – most of whom would have otherwise died. They call themselves “resuscitationists” and high hope in their work is saving lives. 

 But none of this is the best part of the story.

 In 2008, using traditional resuscitation techniques, the survival rate at Sharp Memorial Hospital for out-of-hospital cardiac arrest patients was 8% - in line with national averages. By 2014, four years after implementing VA-ECMO for refractory cardiac arrest, the survival rate jumped to a stunning 28%.  One could easily attribute the improved survival to the use of the life-saving procedure, but remarkably, even after adjusting for the VA-ECMO cases, the survival rate for those not receiving VA-ECMO was still 28%!  How could this be?  Why had the survival rates for all major cardiac event patients in the ER risen so dramatically in just four years?

 Dr. Bellezzo, after evaluating every variable, concluded that his doctors and nurses had changed their views of the potential for survival. “In 2008, there was a nihilism in our ER.  Most of those coming into the ER with cardiac arrest were going to die.  There was nothing we felt we could do about it. 8% survival means 92% failure – and that is awfully depressing. But the VA-ECMO procedure began to change that.  Our teams started seeing that we could save far more people than they first believed and the power of hope became a core value.  Hope became the bridge between the impossible and the possible.  Once our doctors and nurses believed they could save more patients, our survival rates went up regardless whether the cardiac patient received VA-ECMO or not.  We created a culture of hope.  Doctors and nurses believed we could save more people and then patients and their families began to believe.” 

 The culture of hope is now saving more lives than ever at Sharp Memorial Hospital.  In fact, Drs. Bellezzo, Shinar, and Weingart, are inspiring Emergency Department (ED) physicians around the globe.  They host a international educational podcast to educate doctors called the ED ECMO Podcast (www.edecmo.org).  And they host an international ED ECMO Conference called Reanimate (www.reanimateconference.com)- teaching resuscitationists all over the world  to embrace their growing culture of hope.

 Bellezzo’s dream is now to put a mechanical chest compression device on every ambulance with hopes to identify and transport patients with cardiac arrest.  Bellezzo says it best, “We can save many who are truly too vital to die.”  Some have even proposed ECMO implementation in the pre-hospital setting. In France, where the transport of arresting patients is logistically challenging, pre-hospital ECMO is gaining hope.  In one case, ECMO was used to save a patient who arrested on the floor of the  Louvre in Paris - amid art patrons and famous paintings dating back hundreds of years.

Diane is alive today because of the culture of hope that has been established in the Emergency Department at Sharp Memorial Hospital. An amazing team believed they could save her…then her boyfriend, Ron…and her sister, Joanne, believed. Then, her friends and family believed. In Joanne’s words, “The grace of God and the power of hope saved my sister.” In Ron’s view, “The science of ECMO opened the door to the science of hope.” It is a sacred honor to love someone who has been touched by death. Ron and Joanne will cherish that honor for many years to come with Diane.

The most recent research on VA-ECMO is now finding “save rates” as high as 40% in Minnesota as doctors perfect the procedure and implement Dr. Bellezzo’s protocols faster and faster in cardiac arrest patients across the country. Minutes matter in the science of ECMO – as they say in cardiology, “time is muscle.” The notion of “ED-ECMO” is becoming a philosophy never imagined before 2011 and it is beginning to save lives in other emergency departments all around the world. So far, just 13 hospitals in the country have implemented ED-ECMO but many more will learn what it means to have a “culture of hope” in the years ahead.

What if we all lived in a culture of hope? What if we all worked in a culture of hope?  What if everyone dealing with childhood trauma, challenges and difficulties found a place where hope was so high that it invaded their lives as they soon as they arrived? What if our families had a culture of hope? What if every marriage had high hope?

 Joe Bellezzo says his colleagues and friends laugh when he says hope is real and when he talks about hope being the  “bridge between the impossible and the possible.” Many people think hope is just an emotion or just a wish or a prayer – or that it is not real science or any part of “real” medicine. Diane McGrogan is certain they are wrong. Twelve days after suffering her heart attack she walked through the Emergency Department at Sharp Memorial Hospital and thanked her hope-givers. They were real people with real hope – doctors and nurses who work in a culture of hope.