“Everybody from the doctors to the nurses to the transporters treated me so well, like I was family,”
Taking a walk to appreciate the autumn leaves. Watching hawks circle and perch in her backyard. Attending her son’s first high school football game and cheering for her daughter at her first rugby tournament. These are some of the joys Sara Adair loves, but almost didn’t get the chance to experience after she suffered a life-threatening aortic dissection at her Hunterdon home last summer.
Sara now has a new lease on life thanks to innovative Point-of-Care Ultrasound (POCUS) technology available at Robert Wood Johnson University Hospital (RWJUH). This technology enabled an immediate diagnosis in the Emergency Department, saving critical time and significantly improving her chances of survival. RWJUH is an RWJBarnabas Health facility.
An aortic dissection is a tear in the wall of the aorta, the body’s main artery that carries blood from the heart to the rest of the body. This condition is often fatal and patients require emergency surgery if they reach the hospital in time.
POCUS allows clinicians to visualize how the heart is functioning immediately at the patient’s bedside. It also helps clinicians to evaluate hemodynamic changes and pathological heart diseases.
Last July, Sara was home with her family when she experienced sudden chest pain unlike anything she’d felt before. Within a minute, the pain moved down her neck.
“I walked about 20 feet from the playroom to our living room and collapsed,” Sara recalled.
Sara’s husband called 9-1-1 and a team of first responders arrived within minutes. They inserted a tube in her nasal passage, which helped her breath and re-gain consciousness.
“My husband said I woke up and started barking orders at everyone,” Sara joked. “He said I told them that I knew what this was and to take me to RWJUH in New Brunswick.”
Sara had first-hand knowledge of the high-level cardiac and emergency care that RWJUH provides. She has worked at RWJUH since 2000, first as an x-ray technologist and currently as an analyst for RWJBarnabas’ Enterprise Imaging Team.
When she arrived at RWJUH’s Emergency Department, Cardiology Fellow, Shawn Chawla, MD, thought she may be having a heart attack due to her abnormal electrocardiogram readings. However, using POCUS, Dr. Chawla quickly identified the ruptured aorta. A CT scan confirmed the diagnosis, and Sara underwent emergency surgery performed by Hirohisa Ikegami, MD, Assistant Professor of Surgery at Rutgers Robert Wood Johnson Medical School (Rutgers RWJMS) and Surgical Director of the Advanced Heart Failure and Transplant Program at RWJUH.
Sara doesn’t remember much about being taken to RWJUH, but does recall suspecting that she had an aortic dissection – something both her sister and father were diagnosed with previously.
“I had never felt that type of pain before,” Sara explained. “My sister had this two years ago, so I guess I was waiting for the other shoe to drop.”
Following her sister’s aortic dissection, both sisters were diagnosed with Loeys-Dietz Syndrome – a genetic disorder affecting connective tissue that protects, supports and gives structure to all other tissues and organs in the body, including the heart. It can enlarge the aorta, which can lead to a bulge (aneurysm) or tear (dissection).
According to Partho Sengupta, MD, DM, FACC, FASE, Henry Rutgers Professor and the Chief of Cardiology at Rutgers RWJMS and RWJUH, rapid, accurate diagnosis and intervention are critical to achieving a successful outcome for aortic dissection patients.
“Physicians correctly suspect this diagnosis in as few as 15 to 43 percent of cases of verified AAD (aortic aneurysm dissection),” Dr. Sengupta explained. “If left untreated, the risk of mortality increases by one to two percent each hour it is untreated and approaches 50 percent in the first 48 hours after the onset of symptoms. Despite a wealth of literature, a significant number of aortic dissections are missed in the emergency department.”
Dr. Sengupta has pioneered the use of cardiac POCUS in national societies. As Chair of the American College of Cardiology’s 2023 Innovation taskforce that developed a workbook on the use of cardiac POCUS, he noted that POCUS has become an extension of the standard cardiac care patients receive when they arrive at RWJUH. This is due to the special training program that has been developed for clinicians specializing in cardiovascular care.
“Through our Innovation Center and the clinical trials that we have performed with POCUS, we are able to train our physicians to use this as an extension of care,” Dr. Sengupta explained.
Dr. Sengupta notes that not all physicians are trained in POCUS– reading the data requires a “very specific diagnosis performed by trained physicians and imaging specialists.” He added that currently cardiologists, emergency room physicians and critical care physicians have clear training needs outlined. The Division of Cardiology is also conducting clinical trials and educational initiatives to investigate how hospitalists can use new collaborative technologies to acquire and transmit cardiac POCUS images to cardiac imaging specialists to provide multidisciplinary care of patients admitted with cardiac conditions.
“Offering POCUS at the bedside in the Emergency Department as a best practice and extension of care is another example of how RWJUH continues to pioneer new treatments in an effort to offer lifesaving therapies for more patients in our communities,” noted Mark J. Russo, MD, MS, Professor of Surgery and Chief of Cardiothoracic Surgery at Rutgers RWJMS and RWJUH. “In Sara’s case, she benefitted from access to this advanced diagnostic technology with clinicians trained in its use and later the advanced capabilities of a skilled surgical team with experience in addressing complex cases like hers.”
While Sara faced complications after surgery, she is recovering and hopes to return to work at RWJUH and volunteer at her children’s school activities soon. Sara is grateful for the team at RWJUH who saved her life and the support she has received from her colleagues there. She appreciates each new day that she has been given.
“Everybody from the doctors to the nurses to the transporters treated me so well, like I was family,” Sara said. “I went on a walk the other day – farther than I have since this happened. I was watching all the leaves falling and I started thinking – I love this time of year and I almost missed this.”