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Kelsey Greco, Nu’23

“The monitors in the patient rooms on the Cardiothoracic Intensive Care Unit at Duke Medical Pavilion all look roughly the same. At the bottom, there might be a cardiac index or a cardiac output value.

Above that, a waveform from a pulmonary artery catheter. Nearing the top, an arterial line waveform that can be assessed for a dicrotic notch. There also might be a core blood temperature or a respiratory rate. Up until recently, at the very top of all thirty-two monitors on the unit, there was always a heart activity waveform and a heart rate.

Up until recently.

On Monday, July 12, 2021, Duke’s cardiothoracic surgeons, working with surgeons from France, performed the first-ever Carmat artificial heart transplant in North America. That same day, the patient who received this transplant rolled into a room in Duke Medical Pavilion’s Cardiothoracic ICU.

On Wednesday the twenty-first, I helped care for this patient who no longer had a heart rate value or an electrical-activity-based waveform on his monitor. Instead, a tablet on a small red cart showed the flow rates of blood moving through and powering his new artificial heart.

Throughout my day of working with this patient, I learned about the Carmat machine extensively. While charting on the device every hour, the nurse must document the flow rates on the right and left side of the Carmat’s “ventricles.” This heart is not powered by the firing of a sinoatrial node (or any intrinsic electrical power). Instead, it senses the body’s blood pressure and adjusts blood flow accordingly. The Carmat was just recently approved by the FDA to be used in the United States as a transitional device for heart failure while a patient waits for a human heart transplant. It differs from and may be better than other artificial heart devices because it is more compatible with human tissue.

Our day began with a visit from physical and occupational therapists. I worked with this patient a few times over the summer before he received his artificial heart, and due to his precarious month’s stay in the Cardiothoracic ICU, he hadn’t been moving much, and his muscles needed to begin to relearn how to work properly again.

All around this patient’s room, there were posters with pictures of him and his family, which intimately showed the life that he had before he received his unexpected heart failure diagnosis in June. With the Carmat device, he could more easily get back to that beautiful life while he waited for a human heart transplant.

I performed a physical assessment on this patient every four hours, and it was almost the same as any other cardiothoracic critical care patient. The biggest difference was that instead of hearing the “lub dub” of heart sounds S1 and S2, or the whirring of a left ventricular assist device, a sound something like the squeaking of a wet shoe reverberated loudly through the stethoscope. If someone were to listen closely, they could hear it outside of his body, too.

I’ve been working in the Cardiothoracic ICU at Duke as a nurse extern for nine weeks. I’ve helped care for patients recovering from human heart transplants, valve replacements, lung transplants, and many other cardiothoracic conditions. The role of the nurse on this floor cannot be overstated. The care that these nurses provide is a huge part of what allows the patients to be transferred to the step-down units, and hopefully, back home. I’m inspired by nurses, patients, and providers during every shift that I work. I can see a future of critical care nursing in front of me because of every inspiring, exhausting, and exhilarating experience that I’ve had throughout this past summer.

My preceptor RN and I spent a full twelve-hour shift caring for and monitoring the first patient in North America with a Carmat artificial heart device. This assignment was a once-in-a-lifetime experience, and I’ll probably never be in a clinical experience quite like this one again. The morning of July twenty-first, I met a moment in history, and hopefully, a moment of the future, too.”

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