Dr Abhay Divekar's all
smiles
Photo courtesy of Health
Sciences Center, Winnipeg |
"It had been on my mind, that there
had to be a better way to do this, but it was really
just a spur of the moment idea," recalls Dr Abhay Divekar.
A few weeks ago the Winnipeg pediatric cardiovascular
surgeon attained celebrity status when he saved a baby's
life by jury-rigging a heart/lung bypass out of a dialysis
machine and an oxygenator that happened to be lying
around. Now, his quick thinking and ingenuity is set
to be adapted for other Canadian hospitals that lack
expensive pediatric heart equipment.
THE
RIGHT IDEA
Lucky baby Keith Porcher was born on January 21 by emergency
c-section. The doctors didn't know it at the time, but
he had inhaled meconium (his first bowel movement) in
utero, which caused a severe infecti0on in his lungs.
Breathing tubes were put in to try and improve airflow
and get more oxygen to his organs, but to no avail.
Dr Divekar was called in to assess the damage to his
heart.
"Structurally, his heart was normal,
but there was evidence of very high pressure in the
lungs," he says. "I thought, if we can find a way for
this child to survive this, he will be perfectly normal."
The baby was a good candidate for
extracorporeal membrane oxygenation (ECMO): blood is
pumped from the patient through an oxygenator, which
mimics the gas exchange process that occurs in the lungs,
and returned to the body. It's considered a therapy
of last resort, but generally has a high success rate.
Unfortunately, there's no ECMO
equipment at the Winnipeg Health Sciences Centre Children's
Hospital — as far as Dr Divekar knows it's only
available at specialized cardiac centres in Vancouver,
Edmonton, Toronto and Montreal. And Dr Divekar had a
hunch Keith wouldn't survive the four-hour transport
to Edmonton.
Stuck between a risky transport
and doing nothing at all, Dr Divekar suddenly had a
flash of inspiration. "All we needed was a pump and
a membrane," he says. "We do a lot of CRRT [continuous
renal replacement therapy] here, so I thought, why not
use that?"
MAN
vs MACHINE
CRRT is similar to dialysis, except that patients are
kept on it continuously. It's essentially the same setup
as a bypass. "You're taking blood out, putting it through
dialysis and putting it back," explains Dr Divekar,
"so why can't we just attach a lung to it?"
He approached the nephrologist
who heads the CRRT program, the nurses there and in
the ICU, and the perfusionists — and no one could
see why they couldn't. "We all came together, not one
person said 'No'," says Dr Divekar. "It was awesome."
After a few trial runs and a little
tweaking, the team of medical mavericks were confident
the setup was safe. "At first, the alarms on the machine
kept going off," Dr Divekar says. "We had to figure
out how to make the machine think it was doing the right
thing, even though technically it wasn't, and at the
same time be sure it didn't actually do the wrong thing.
We had to play its brain for a little bit." Just four
hours after the lightbulb first went on in his head,
they were ready for the big show.
SWEET
SUCCESS
Once the baby was put on the improvised bypass, he improved
very quickly. "Over the next six hours, we were down
to nice numbers and were confident we had done what
we needed to do," says Dr Divekar. A few days later,
Keith's grateful parents were able to take him home.
But for Dr Divekar, that was just
the first step. He intends to research his experimental
technique more thoroughly, in the hopes that other centres
that don't have access to ECMO can offer patients an
alternative. "We didn't invent anything, we just put
things together to provide the support needed," says
Dr Divekar. If he can reproduce the results in experimental
studies, he says there's no reason why a select subgroup
of patients couldn't be candidates for similar treatment.
"That's my most important objective," he says, "to research
this and see if it's possible to give these babies a
chance at survival."
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