New Ascension Seton protocol saves Kyle man after his heart stopped

Nick Gegen went to bed on Monday, Aug. 18, after feeling a little weird, like he had acid reflux. At 2 a.m., he woke up gasping for air. His wife, Syndle, asked him if he was OK, then watched him fall backward on the bed and become unresponsive. 

When she turned on the light, she saw his eyes were open but glazed over. She called 911. The dispatcher told her to get him onto the floor and guided her through CPR. Within six minutes, police arrived to their Kyle home, followed by an ambulance. They took over the CPR while Syndle called her sister to care of their two children, who slept through the commotion.

After three shocks from an automated external defibrillator, Nick Gegen’s heart began to beat again. Syndle Gegen watched his color return.

Gegen, 35, had been the picture of health. He has no memory of the next 10 days, but he benefited from a new approach to how Ascension Seton provides the life-saving extracorporeal membrane oxygenation at hospitals outside Ascension Seton Medical Center in Austin where the ECMO team is based.

ECMO moves the blood around the body without the use of the heart. It gives the heart time to either heal and pump on its own again or serve as the bridge to an assist device or heart transplant.

“He needed it to survive,” Syndle Gegen said of ECMO. 

Previously, the ECMO team and a cardiac surgeon would travel from the Austin hospital to the patient’s hospital to connect the patients to the machine. The team services hospitals throughout Central Texas, not just those in the Ascension Texas system.

Once the patient is hooked up to ECMO, the team would bring the patient by ambulance back to Ascension Seton Medical Center, where the patient would stay until they healed, had a device implanted or received a heart transplant. 

That process could be slow, said Megan Landon, an ECMO nurse and coordinator at Ascension Seton. With Austin traffic, she said, it could be a two to three hours for the team to reach a patient.

“Every minute matters,” she said. “Can we be faster at this?”

She identified three hospitals to try a new protocol: Instead of waiting for the traveling team to begin, surgeons at those hospitals were trained to prepare patients for ECMO by placing cannulas into veins while the ECMO team was en route. Once the team arrived, connecting the patient to the machine took less time.

Dr. Sachin Mehta, an interventional cardiologist who works at Ascension Seton Hays Medical Center, was on call when Gegen came into the emergency room.

First they tried to figure out what was causing the problem with Gegen’s heart. An electrocardiogram showed no sign of a heart attack. An ultrasound didn’t show any blockage, and tests in the catheterization lab also didn’t show any blockage.

Tests did reveal that Gegen’s heart function had been profoundly weakened, Mehta said, but they didn’t know why. His best guess was a virus that went to the heart muscle. When that is the case, the heart function drops rapidly instead of slowly worsening, he said.

Mehta began preparing Gegen for ECMO and a balloon pump to let his heart a rest. By the time the ECMO team arrived from Austin, the prep work was complete. Gegen was quickly hooked up to the machine and transferred to Ascension Seton in Austin with the ECMO team supporting him along the ride.

Gegen was the first patient at Ascension Seton Hays to experience the new ECMO protocol. Next year, the team will train doctors at Ascenion Seton Williamson Hospital in Round Rock and then Dell Seton Medical Center in downtown Austin.

Gegen responded well on ECMO, which kept his blood circulating while his heart healed. By Saturday, Aug. 23, doctors began turning down the machine to start weaning and monitoring his heart. By Monday, Aug. 25, a week after his cardiac arrest, his was off ECMO, and the next day, his balloon pump was removed.

By Wednesday, Aug. 27, he was no longer on ventilation and could speak. His first question was about how the Dallas Mavericks were doing, even though it wasn’t basketball season. 

“He does love basketball,” Syndle Gegen said, though he’s more a LeBron James fan. 

Nick Gegen remembers nothing from the time he went to bed that night to the time he woke up 10 days later. He knows he dreamed about his work in real estate investments. His heart is fully healed, but he needed months off work because of the effects of being in the intensive care unit and anesthesia. He had some memory fog and muscle weakness. He has some loss of peripheral vision in one eye that might return. 

What happened to Gegen remains puzzling to him and his wife. “It’s a weird fluke,” Nick Gegen said. “What a trip this has been,” he said. 

Syndle Gegen will always be able to say to him: “Remember that time I saved your life.”