Welcome everyone to the Becker's Healthcare podcast series.
I'm Moriah Muhammad, writer and moderator with Becker's
Healthcare, and I'm thrilled to have with me
today 3 special guests. Doctor Sunita Ferns, director
of pediatric and adult invasive electrophysiology,
doctor Harma Turbendian,
pediatric cardiac surgeon, and last but not least,
doctor Mark Plunkett, chief of pediatric and congenital
heart surgery,
all from OSF Children's Hospital of Illinois.
Doctors, welcome to the podcast. We're very excited
to have you join us today. Today, we
are going to be discussing the story of
how a 2 year old, child suffered sudden
cardiac arrest at home,
and how your hospital dealt with it, and,
specifically, doctor Firms playing a huge part of
it.
So if you all wouldn't mind, let's kinda
go to the beginning of the story and
get, some background information.
Doctor Turbendian, like I stated, this is the
story of care for the toddler really started
at home. So can you tell us a
bit about the parents' quick actions and how
we got to the procedure?
Right. So,
this was a young, otherwise healthy child who
is at home, and,
the parents
realized
at home that he was having a cardiac
arrest and
started
CPR
and and called 911.
And, really, it was,
it was amazing that the parents acted,
so quickly and knew what to do and
knew how to get the child further help.
So they were essentially able
to perform CPR, keep them alive until EMS
got there. They continued CPR
and resuscitation
and got them over to the, intensive care
unit,
here at Children's Hospital of Illinois.
Wonderful. Thank you so much for giving us
that that,
important information to the story.
Doctor Ferns, kinda going to you next. What
diagnosis did you give the child,
and, what plan of care came next?
So,
you know, initially, the trial presented with cardiac
arrest of, unknown origin, and the clock was
ticking for us to
pin down a diagnosis.
And so we we had a a host
of diagnostic tests we do in the ICU.
We send off genetic testing and, a host
of antiarrhythmic
medications. Those are medicines that are specifically used
to treat these arrhythmia syndromes.
And, because this child's presentation,
was a bit unusual,
he did not fit into any of the
usual categories. The diagnosis was, was initially somewhat
challenging and, through a method of trial and
error, we were finally able to pin down
a medication that would work for this child.
So ultimately, the diagnosis was something called Brugada
syndrome.
And, the drug that we used to treat
it was something that was invented for malaria.
It's a drug called quinidine,
and it worked, exquisitely well for this child.
But, of course, he also had to get
a defibrillator because once you try to die
once, we don't let that happen again, and
that's when the surgeons were involved.
Got it. Got it. Thank you so much
for giving us that information.
Doctor Plunkett, going to you next, can you
tell us about the magnitude
of doing such a procedure on a child
this young and small?
The magnitude of implanting this, device,
in this, child is huge. This is the,
smallest and youngest
patient to have,
this device implanted.
This is relatively new technology and was designed,
for adults or adult sized
patients.
And the fact that we've,
shown that we can safely,
and effectively,
implant this device,
in a a small child,
expands its application,
immensely.
Now,
this device will be used
in children,
with a similar
rhythm, issues,
in addition to its adult application.
Wonderful. Yeah. I'm I'm very happy to hear
this device is now being able to help,
you know, such young people.
Doctor Ferns, you're now in charge of this
child's post procedure
care. What is this family's journey going to
look like from here on out, and what
are you keeping an eye on, during his
treatment time?
That's an excellent question. So, you know, once
the child's been diagnosed with the malignant arrhythmia
syndrome,
we encompass not just the child, but also
our screening and determination of other people at
risk in the family extends to the immediate
family members. And then if that comes back
as positive, also the extended family members. So
what we start doing is extending the genetic
testing,
to the rest of the family. But for
this child specifically,
we have to make sure that he gets
his medications on a very,
regular regime because even missing a dose here
and there could be catastrophic and could lead
to a life threatening arrhythmia.
He, of course, has
the
implanted defibrillator
to help him, but our aim of giving
him an implanted defibrillator
is not so much to let him keep
getting shocks, but to be
able to determine
a life threatening arrhythmia and get on top
of it before the device actually shocked him.
So,
the implications for this child going forward, I
would say, you know, you need a normal
life like any other 2 year old growing
up and,
knowing that,
he needs to take his medications regularly.
And,
at some point in the future, about
12, 13 years from now, the battery for
that defibrillator will need changing. So he will,
come back for battery replacements,
but
I don't, anticipate him
leading anything,
short of a normal life.
That's really, really good to hear. That is,
you know, kinda high stakes, but,
I'm sure everything is going fine right now
and will continue to to go fine.
Doctor,
Turbendian, going back to you, can you take
us to the operating room a little bit?
What kind of team effort was needed to
do this procedure?
Yeah. There was a there was a decent
amount of coordination
that went into it. You know, after the
child presented and and
doctor Ferns and the team
sorted out what was what was going on,
what the diagnosis was, and what the child
needs were gonna be.
When
she came to us, you know, asking about
the feasibility of the device
being implanted in a child this small, and
we had to talk to and coordinate not
only our
operating room and operating room staff down here,
but,
along with doctor Ferns, we also had to,
coordinate with the manufacturer,
as this was gonna be, you know, the
first time this was implanted in a in
a channel this young. So we had
to put a bunch of teams together to
to make it happen in a in a
relatively rapid fashion.
And I think it was
exciting and reassuring to see how,
enthusiastic
people were to,
give this child the the opportunity
to get this device.
Yeah. Yeah. Definitely. Well, I'm glad that, you
know, everything was able to work itself out,
with all those different people coming together.
Doctor Plunkett,
can you talk a little bit about the
EVICD
a bit more?
Before this was available, what other treatment options
what a surgical team have considered?
Yeah. Well, what we have to keep in
mind is,
traditionally, like, transvenous systems were were only applicable
to,
older
children and adults.
As you got into the younger age ranges,
the
ICDs,
that we had to implant,
required,
sternotomies or thoracotomies.
There were epicardial
patches that you would actually, sew on the
surface of the heart or around the heart.
There were coils and even what were called
subcutaneous
arrays.
But all of these technologies
had their limitations,
and
this newer
EVICD
seems to be a great advancement,
in technology.
And, the fact that we can implant it,
with such a minimally invasive approach, if you
will,
and have a higher level of technology
is, is really great because now we can
avoid,
all those, much larger procedures,
for these children.
Yeah. Yeah. Definitely. Especially because they are just
so young. You know?
Doctors, thank you all for being here. Before
I close out,
do any of you have any ending thoughts
for anything we discussed today,
and about what the surgery means for the
world of medicine?
Doctor Ferns, do you have any final thoughts?
Well, I think this is a groundbreaking.
As doctor Plunkett mentioned earlier,
the
ability to do this in a child is
young, minimally invasively,
has huge implications going forward.
And,
I I think a lot of the centers
are going to follow suit didn't adopt this
fairly rapidly.
And I think, you know, this
procedure,
and the way it was done will help
reduce disparities
in,
the availability of, care
across the globe.
To give you,
a reference,
this was a relatively
straightforward procedure for doctors, Taubenian and Plunkett on
a scale of what they do.
They do very complex cardiac surgery because they're
specialized pediatric congenital cardiac surgeons.
And on a scale of 1 to 10,
this would be a one for them and
ten is the most complex surgeries they're doing.
So the ability to do this in a
minimally invasive way would mean that this procedure
could be made available to patients
across the globe where they don't have the
experience of experienced cardiac surgeons,
and patients may not need to be transferred
to a congenital heart center. And this could
be done
in a relatively straightforward way by a a
general surgeon, a thoracic surgeon, and,
I think it has
a way it's a means to reduce, disparities
in accessing health care across the globe.
Yeah. Yeah. Definitely. Doctor Plunkett, did you have
any final thoughts as well?
I I would just add that,
in the world of of pediatric
medicine and and surgery,
it's not uncommon for us to, take,
what's been designed or developed, for adults
and,
apply it,
or or use it in the treatment of
of children. This is the
the way a lot of our pediatric, devices
and a lot of our technology is is
developed. So
I think this, is just one more example
where we've
been able to take what, what exists and
what's been designed for the adults
and, and prove that it, is effective and
and safe, to be used in children.
Yeah. Yeah. Absolutely.
And doctor, Taubindian,
did you have any final thoughts as well?
Yeah. I think,
none of this would have happened if it
wasn't for the parents'
quick actions and their and
the fact that they knew how to do
CPR.
And so I think it's just, you know,
from a
kind of public health perspective, it's just another
reminder of, you know,
people have some basic knowledge of CPR.
You can definitely save a life. And like
I said, we wouldn't have done this if
it wasn't for,
the quick actions of the of the parents
at the at the onset of this whole
story. Mhmm.
And just to reiterate,
the novelty of the procedure and what doctor
Plunkett and doctor Ferns have referred to, we,
in order to spread the word about
the possibility of doing this, we actually,
just published the report
regarding the child in the,
Annals of Thoracic Surgery short reports.
And so that's,
really available to,
any provider to
read about what we did.
Yeah. Absolutely.
Thank you all so much for those final
thoughts. This has definitely been a very informative
discussion.
I know I definitely learned a lot,
through this story. Again, I wanna thank you
all so much for coming on Becker's HealthCare,
and I look forward to connecting with you
again soon. Thank you.
Thank you very much.