ECMO to LVAD to Heart Transplant: John Hamblin’s Race to Recovery
John Hamblin began running in half marathons—the majority of them in the St. Louis area—when he was in his mid-40s. Then he discovered 50-in-50 clubs, members of which set the goal of running half or full marathons in all 50 states. Hamblin was inspired, and between 2009 and 2015, he ran half marathons in 15 states. He was scheduled to run his 16th in Oklahoma City at the end of April 2015.
But then came April 12.
“I woke up at 3 a.m. having trouble catching my breath,” says Hamblin. “I had recently been diagnosed with asthma, so I thought I was having an asthma attack.”
John’s partner, Jim, closed the windows and turned on the air conditioner in the hope of eliminating asthma triggers. By mid-morning, however, Hamblin was no better.
“That’s when Jim took me to Barnes-Jewish Hospital’s emergency department, where they immediately gave me an EKG,” says Hamblin.
An EKG, or electrocardiogram, measures the electrical activity of the heartbeat. Each beat produces an electrical impulse that makes the heart pump blood. Hamblin’s test showed that he had atrial fibrillation, an irregular heart rate that increases the risk of stroke, heart failure and other heart-related complications.
“We tried electrical shock, intravenous antiarrhythmic medication and a balloon pump—a mechanical device that helps the heart pump blood—to bring Mr. Hamblin’s heart rate back to a normal rhythm, but none of these were effective,” says Akinobu Itoh, MD, PhD , a Washington University transplant surgeon at Barnes-Jewish Hospital and the surgical director of the heart transplant program. “That’s when my colleague, Dr. Faraz Masood, decided to place him on extracorporeal membrane oxygenation treatment.”
Also known as ECMO, this treatment is a life-support system similar to the heart-lung bypass machine used during open-heart surgery. It functions as a temporary artificial heart and lung for a seriously ill patient whose own lungs and/or heart are not functioning well enough to sustain life. Hamblin remained on ECMO for a week.
“We initially thought his heart problem was the result of myocarditis, a heart condition caused by a virus that attacks the heart muscle, causes inflammation and prevents the heart from beating properly,” says Itoh. “We tested Mr. Hamblin’s heart during the week he was on ECMO to see if he could sustain good blood circulation when support was decreased. Unfortunately, his ejection fraction—the percentage measurement of blood leaving the heart each time it contracts—remained well below what is considered an acceptable recovery rate.”
That’s when Itoh and Gregory Ewald, MD, a Washington University cardiologist at Barnes-Jewish Hospital and medical director of the heart transplant program, recommended Hamblin undergo implantation of a left ventricular assist device, or LVAD—a battery-operated, mechanical pump that helps the left ventricle pump blood to the rest of the body.
“We were unable to pinpoint the cause of Mr. Hamblin’s heart problem. However, if it was myocarditis, there was a possibility the LVAD would help his heart recover enough so that we could remove the device,” says Itoh. “If that didn’t happen, Mr. Hamblin could remain on the LVAD for a number of years without experiencing a problem. Or the LVAD could be used as a bridge to a heart transplant.”
In the end, that last possibility was the one that became a reality for Hamblin.
“I was released from the hospital with the LVAD on Thursday, May 14,” says Hamblin. “By that weekend, I was back with my running/walking group. Although I walked less than a quarter mile that day, by the end of the summer I was walking eight and a half miles. I was planning to go back to my job as a statistical writer, but that never came about.”
Instead, Itoh and Ewald recommended that Hamblin be placed on the wait list for a heart transplant.
“We considered three factors in making this decision,” Itoh says. “First, a low percentage of patients recover sufficiently to allow the removal of an LVAD, and the patients who can don’t do well in the long term. Second, Mr. Hamblin has AB blood type, which means he is a universal recipient: He can receive an organ from any blood type. And third, as a runner, he is in great shape,” says Itoh. “Overall, we felt his best chance for survival was undergoing heart-transplant surgery.”
After 19 days on the transplant wait list, Hamblin received his new heart. “This was exceptionally quick, and it was due to his rare blood type. Patients needing heart transplants who have blood type O or A wait an average of two years,” says Itoh.
Almost immediately after his transplant surgery, Hamblin started walking the halls and climbing the stairs at Barnes-Jewish Hospital.
“From the start, my attitude was that I would do whatever I needed to do to get healthy, stay healthy and get a new heart,” says Hamblin. “The physicians helped me stay positive by keeping me informed at every step about what they were going to do and what I should expect. And the nurses gave wonderful support and care.”
Beyond his good physical condition, Hamblin was an ideal candidate for a transplant because of his mental and emotional stability, says Itoh.
“We carefully select our transplant patients because they must make a lifelong commitment to be compliant in taking their immunosuppressive medications. If a patient stops taking the prescribed drugs, within one or two weeks the body can start rejecting the heart,” he explains. “Mr. Hamblin is steadfast in his commitment to his health, and he has excellent support from his partner and family.”
Hamblin is looking forward to returning to work once he is past the six-month anniversary of his heart transplant. In October, he’ll be in Portland, Maine, to complete a half marathon in his 16th state. And then he has just 34 more to go.