This is one of our favorite patient success stories where use of the ECMO heart-lung machine helped save a teenager’s life. In 2009, Piedmont was one of the first hospital’s to use this life-saving therapy, and we remain one of the few to use ECMO today.
Scott Dolezal could have been anywhere when his heart stopped in August 2009. But the then 17 year old happened to be alone in the woods, finishing the final half mile of a high school cross country race.
“When Scott was a week old, he had cardiac surgery to correct a rare, congenital heart defect,” says Lucy Mueller, Scott’s mother. “Ever since then, we’ve had annual follow-up visits with a pediatric cardiologist.”
As Scott’s heart grew and naturally rotated, his coronary artery gradually kinked and became pinched between large vessels that stretch with blood every time he exercised. At any time, too much of a kink would reduce the amount of blood supply to his heart and could lead to a heart attack or sudden death.
“We’ve always known he had a risk,” says Lucy Mueller, “but every year he was cleared to continue playing sports. I was so happy when they started putting AEDs (automatic external defibrillators) in schools because I’ve always had that worry in the back of my mind. I just never thought it would happen.”
Alone in the woods, Scott’s risk became reality. He had a cardiac arrest, lost his balance and tumbled into a ravine that snaked along the running trail. Luckily, just moments before, a school groundskeeper decided to bypass spectators crowding his path by making a detour through the woods. He carefully passed a healthy looking, steady runner and continued on. A few seconds later, something made him look back over his shoulder – just in time to witness Scott disappear from the path. Doubling back, the groundskeeper found the runner tangled in some branches above a creek.
A simultaneous 9-1-1 call and strident yell for help yielded a couple of boys and one of the boys’ parents, Piedmont surgeon Bill Barber, M.D..
Craig Dolezal, Scott’s father, says, “Scott was one of the last three runners, so I was standing near the other parents waiting for him to come out of the woods. When I heard, ‘Runner Down!’ I knew there was a good chance it was him.”
Meanwhile, Dr. Barber scaled down the ravine to get under Scott’s bed of branches and lift him up to where the boys could pull him safely to the path. He began CPR while athletic trainers assisted. He then shocked Scott’s heart twice with the school’s AED.
“Scott was the color of ice – blue-white,” recalls his father. “His coach was kneeling over him screaming, ‘This is your race, Scott! All we need is one breath. Then we’ll take two…’”
Scott finally took a raspy breath and a faint pulse returned. He was still unconscious as an ambulance raced him to the Piedmont Hospital Emergency Department (ED). Riding along, Dr. Barber called ahead to the hospital, and an entire team of caregivers gathered to await the runner’s arrival.
“Lucy was already at the hospital because she was working. I raced ahead of the ambulance, so we were all there at the ED entrance,” Craig Dolezal recalls. Scott’s mother, Lucy, is a nurse at Piedmont Hospital.
Cardiologist Anna Kalynych, M.D., was on call and met Scott in the ED. She made one of the decisions that likely saved Scott’s brain function. “We needed to cool his body down immediately, so we induced hypothermia.”
Piedmont is one of very few hospitals nationwide to use “cold therapy” to preserve cognitive function in patients with cardiac arrest. Called Arctic Sun®, the system pushes cold fluids through hollow pads that hug the patient’s body to lower body temperature and diminish the potential for neurologic damage that often occurs when blood flow is restored. The system essentially paralyzed Scott’s body and induced a coma. His body temperature would remain at a cool 93 degrees for the next 24 hours.
“Scott’s heart and lungs were completely failing,” says interventional cardiologist Vivek Rajagopal, M.D. “The only way to sustain his life was to put him on extra-corporeal membrane oxygenation, or ECMO.”
Routinely used in the operating room (OR), ECMO is used to bypass the heart and lungs. It maintains blood flow and oxygenation to the vital organs, like the liver, kidneys and brain, so organ function is maintained while the heart and lungs recover.
Cardiothoracic surgeon Morris Brown, M.D., and the OR perfusion team were in the cath lab to assist Dr. Rajagopal. They used the TandemHeart®, a continuous-flow centrifugal assist device placed outside the body, as a platform to deliver ECMO.
“Very, very few hospitals in the country have the TandemHeart pump,” says Dr. Kalynych. “But this device saved Scott’s life.”
The TandemHeart® was connected to Scott’s body via two percutaneous (through the skin into a blood vessel) access points in his right leg.
“Maximizing blood flow in the leg is a common challenge any time ECMO is used,” says Dr. Rajagopal. “The ECMO tubes are large, and Scott has small arteries, so both elements contributed to the challenge of keeping sufficient circulation to his right leg.”
As a result of these interventions to save Scott’s life, blood clots formed in his right leg. He needed vascular surgery to remove them, but he was too unstable for surgery.
Instead, at bedside in the ICU, a team of specialists including Doctors Brown, Rajagopal and Kalynych, and consulting vascular surgeon Patrick Battey, M.D., along with two technicians from the Piedmont vascular lab, created a percutaneous bypass circuit to provide circulation from the left leg to the right leg. Dr. Rajagopal then performed a peripheral angioplasty to clear a major clot.
While Piedmont physicians collaborated to save Scott’s life, more than a hundred family members, friends, co-workers and school mates packed the waiting room in support.
Scott’s two older brothers, who flew in from out of town, were bedside when Scott first woke up in ICU a few days later. “He looked over at his brother and said, ‘Sup.’ (slang for “What’s up?”) We knew right then we had him back,” Mueller says.
By the next morning, Scott’s heart and lung function had stabilized. Hypothermia was stopped, and his body steadily warmed as he rested in the ICU. Stable enough to be transported, Scott met his entire team of specialists in the OR where ECMO was weaned.
Then, Dr. Battey performed a five-hour procedure to remove additional blood clots in Scott’s right leg. He also performed a procedure to avoid “compartment syndrome,” a complication that can occur when internal swelling damages nerve and muscle tissue.
Unfortunately, despite valiant attempts by Scott, plastic surgeon John David Mullins, M.D., and physical therapy, Scott had to have the lower part of his right leg amputated due to an infection. “These interventions saved his life.” says Mueller, “It was the only choice we had.”
Visitors helped his 51-day recovery in the hospital. He also relied on music. “I’ve been playing guitar since I was eleven.” With seven guitars to choose from, Scott said he could play for hours. “He can sing, too,” Mueller adds.
“One of my best memories about being in the hospital is talking to Dr. Mullins,” Scott says with a smile.
“He came in to change the bandages on my leg every day and would play music on his iPod. I also remember hearing him play classic rock in the OR.”
Quickly outfitted with a prosthetic, Scott is already learning to walk again. “Scott is remarkably stronger than all of us put together,” says Mueller. “In a really short time, he has adjusted and just keeps moving forward.”
In October 2009, Scott, his brothers and parents traveled to the Cleveland Clinic in Ohio to have his heart rebuilt by the same surgeon who performed the rare surgery 17 years ago.
Scott’s father says, “Beyond the set of circumstances that saved him on the trail, one of the great decisions made through all of this was to take Scott to Piedmont. The sequence of events that occurred, including the hospital having the Arctic Sun and the TandemHeart, could have only happened had he been at Piedmont.”