No Crying Allowed by Christopher J. Knott-Craig MD

Author:Christopher J. Knott-Craig, MD [Christopher J. Knott-Craig, MD]
Language: eng
Format: epub
Publisher: ArchwayPublishing
Published: 2018-10-10T04:00:00+00:00

22

The Berlin Heart

It was a Tuesday in July 2006, and I had just taken over for Dr. Al Pacifico as the chief of pediatric cardiac surgery at the University of Alabama at Birmingham (UAB), the mecca of pediatric cardiac innovation and success under Dr. Pacifico and Dr. John Kirklin, and later his son, Dr. James Kirklin.

The phone rang. It was an emergency, the caller said in a voice that sounded agitated, breathless, and desperate. It was the pediatric cardiologist, and he was at the children’s hospital in Birmingham. “What is your philosophy on patients that are coding?” he asked, referring to a situation in which a patient’s heart has stopped.

“What do you mean?” I asked, puzzled.

“Well, in the past we would not consider placing a patient on ECMO (mechanical life-support system) if the patient was coding. But I wanted to know what your position is regarding this scenario. I have a seven-month-old baby here who arrested, and we have been doing chest compressions for about fifteen minutes already in another hospital.”

“Have you stopped chest compressions at all? Do the pupils still react to light?” I asked.

“We have not stopped chest compressions, and I think the pupils are still reacting,” he said.

“Bring her over. I’ll put her on ECMO,” I said. I assembled my team at the side of the fourth bed on the left side of the mixed adult/pediatric cardiac ICU. They wheeled in the infant some twenty-five minutes later, still actively doing chest compressions and ventilating the baby by hand. They had needed to move the baby into an ambulance and transfer her to my hospital and ICU. She had a viral myocarditis and dilated cardiomyopathy.

I expeditiously opened the right side of her neck and placed cannulas in the internal jugular vein and common carotid artery, taking care not to ligate these vessels in the process; this would give the baby a slightly better chance to recover normal brain function. We started the ECMO mechanical support and waited to see whether she would wake up and what neurological deficit would be present. Well, to everyone’s amazement, she woke up the next day and appeared to have no significant brain injury. Even her heart function retuned, although the heart remained weak and unable to support her body. Dr. Jim Kirklin made some phone calls to the Berlin Heart company, and they brought a Berlin Heart to our hospital within thirty-six hours. That Friday, Dr. Kirklin and I placed the Berlin Heart in this baby, with the medical representative pretty much telling us how to do it as we went. This was possibly the first Berlin Heart to be placed in UAB. The Berlin Heart is the only ventricular assist device available for young infants in the United States and until then had only been used very infrequently in the country.

The infant survived the Berlin Heart operation and recovered very well. Although she suffered a few minor strokes during the next eighteen months or so, she remained well, although her own heart never recovered to the point that the Berlin Heart could be removed.

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