When Seconds Count (continued)

‘A Frozen Moment’

The Newborn Young Child (NYC) Team is the portion of the St. Anthony Flight For Life transport team that is housed at The Children’s Hospital. Karen Percell, RN, clinical coordinator for the NYC team, and respiratory therapist Janet Morelli, RRT, were both working the day Ben was born. They received a call about a very sick baby at Poudre Valley, but the winds were extremely high that day, and the helicopters were out of service.

While they waited for clearance to go, Percell and Morelli prepared everything they would need to transport Ben, including ventilators, IVs and medications. They kept in close contact with Dr. Kinsella, who advised them to drive up to Fort Collins.

“Ben had very high settings (on the oscillator),” Morelli said. “I couldn’t do that on my conventional ventilator, which is usually OK for the transport, for short periods of time. I was going to have to hand-ventilate for him.”

Dr. Kinsella said, “The roadblock we had was despite everyone being there to think about this baby and prepare him for transport, it was becoming clear to us we weren’t sure he was going to survive the trip.”

Dr. Paisley said, “The last thing we wanted was for Ben to die in flight away from his family.”

The team of caregivers knew they needed to transition Ben from the tools keeping him alive at Poudre Valley to the tools Percell and Morelli could bring on a helicopter. Because Ben’s lungs were so stiff, Dr. Kinsella determined that the blood in his lungs caused the surfactant in his lungs to be dysfunctional. Surfactant is a substance that reduces surface tension within the alveoli in the lungs, preventing them from collapsing.

“We reasoned that if that was the case, we might be able to overcome that by giving him surfactant down the tracheal tube, which is a long-standing therapy for treating pre-term babies who have immature lungs,” Dr. Kinsella said. “We had to modify that and deliver it very slowly through the high-frequency oscillator, which caused some consternation.”

Morelli said, “You have to be very careful when delivering surfactant through an oscillator; it could suck it in all at once, which could kill him. Dr. Kinsella dripped it in. I’ve only seen it done one other time in 25 years.

“It normally takes five minutes to deliver surfactant,” Morelli said. “With Ben on the oscillator, it took 20 to 25 minutes to deliver the surfactant. We saw immediate results.”

They started to hand-ventilate Ben for his transport to Children’s, and his oxygen level dropped dramatically. Dr. Kinsella tried different settings, and had the same result.

Ben went back on the oscillator while his team of caregivers discussed the options. Then, Dr. Kinsella noticed a small infant percussor, a different kind of ventilator; he adjusted the settings and found it would work for Ben.

Then he attached a piece of plastic to deliver the nitric oxide.

“John invented something,” Dr. Paisley said.

Dr. Kinsella said, “We took him off the high-frequency ventilator and sat at the bedside with everything hooked up so he could go right back on it. We tried this for 10 or 15 minutes, and it became clear that we could sustain his oxygen level and breathe for him adequately, that we could go onto the helicopter and move him back safely (to Children’s).”

Dr. Kinsella started driving to Children’s after giving his cell phone number to Percell and Morelli, who loaded Ben onto the Flight For Life helicopter.

“I waited until the door was shut and the helicopter was off the pad before I walked off the pad,” Dr. Paisley said. “Then the emotions hit me. All I can visualize is his mom, post C-section in her hospital bed, knowing that by the look on all of our faces there was a high chance he may die. It was a frozen moment.”

Because there was no room in the helicopter, Tim rode in the Flight For Life ambulance to Children’s.

“We were driving to the highway and I remember seeing the helicopter fly over us and saying a prayer and saying, ‘you can do this, buddy,’” Tim said.

The helicopter took 19 minutes to get to Children’s.

“It was hard to do patient care in a helicopter with an isolette,” Morelli said. “My heart was pounding and my mouth was dry the whole trip. But his oxygen stayed up.”

Percell said, “This was the sickest baby I’ve ever seen. The helicopter ride was the longest 19 minutes of my life. I had emergency medications drawn up, and tried to be prepared for anything that might happen. I just watched Ben’s numbers and couldn’t wait to get to Children’s.”

Several residents and fellows were waiting on the helipad at Children’s, and together with Percell and Morelli, they rushed Ben to Children’s NICU, a 23-bed unit that provides the region’s highest level of care for newborns and infants.

“I reached into the isolette to pick Ben up and looked over to the other side of the isolette and saw John smiling at me,” Percell said. “He must have grown wings and flew!”

Morelli recalls a similar experience.

“I saw John walking in, and thought, ‘how did he get here so fast?’ I hugged him and said, ‘we made it!’”

“I broke a lot of traffic rules,” Dr. Kinsella admits with a smile.

A New Year, a New Hope

Tim arrived at Children’s and went to the NICU to see Ben; Kim was still recovering from the C-section in Fort Collins.

Dr. Kinsella and his team began to prepare Ben to go on ECMO when suddenly Ben began to stabilize. Amazingly, his condition continued to improve dramatically over the next 24 hours.

“I was literally sitting there minute to minute deciding whether to put him on ECMO,” Dr. Kinsella said. “It is necessary if you think a baby is going to die, but if you can avoid doing it, we prefer to. That’s always a tough call. If I’m wrong then you wait too long and the baby is much sicker. But it turned out he began to improve.”

Kim’s obstetrician and pediatrician decided Ben needed his mom, and discharged her 18 hours later.

“I got there by noon the next day,” she said. “I wasn’t expecting to see what I saw. He had a lot of tubes in him, and there was crusted-up blood all over him. They didn’t want to clean it off because they didn’t want to stress him out. On top of that he was pumped full of fluids, and was so swollen. You could see his little heart pumping through his skin. He would occasionally open his eyes and look at me like, ‘Why is this going on?’ He would try to cry, but he had a mouthful of tubes.”

But each day, Ben continued to improve. By the third day, New Year’s Day, he was moved off the oscillator to a conventional ventilator.

“The fourth day we were there, Dr. Kinsella looked at us and said, ‘This is the first time I feel comfortable saying he’s going to pull through this,’” Tim said. “As a parent, that’s what you wait to hear the whole time. That was like someone took a mountain off my shoulders.”

Ben spent 14 days at Children’s. The first week he continued to recover; he spent much of his second week learning to eat. The last couple of days he moved from the NICU to the Infant Care Center, a 27-bed step-down unit.

“Nobody wants to go to the hospital, but Children’s became our home,” Kim said. “The people there were so incredible and really became our family. The volunteers, doctors, nurses – every single person we encountered was above and beyond exceptional.”

Going Home

“The remarkable thing was how quickly Ben got better,” Dr. Kinsella said. “It was unbelievable.” Dr. Paisley said, “Ben didn’t go home on oxygen. That’s phenomenal given the amount of lung disease he had.” 

Tim and Kim initially were scared to take Ben home.

“Finally, he looked like our normal baby and we could hold him,” Tim said. “It’s like you’re getting out of the comfort zone you’ve raised him in for two weeks.”

“It was amazing to have him home,” Kim said. “We just put him between us and stared at him and cried over him.”

“Dr. Kinsella told us 99 out of 100 adults wouldn’t have survived this,” Tim said. “The nurses told us they’ve never seen Dr. Kinsella come over and just look at a baby and start giggling (after Ben recovered). He’s our angel; we adore him.”

“It was scary, but when it works out, it’s a treat,” Dr. Kinsella said.

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