Heroes, hospitals and helicopters: Cardiac care at 20,000 feet


Everyone knows physicians save lives in hospitals. That’s where they do most of their work. But the story of my daughter’s medical emergency is a little different. How she survived a medical flight from Iowa City, Iowa, to Boston is straight out of MacGyver!

Caroline was born with primary pulmonary venous stenosis (PVS), a dangerous disease that took her brother Benjamin’s life.

[T]he nurses were trying everything to keep her stable. The flight team desperately needed guidance.

When she was just over a month old, Caroline was flown to the Boston Children’s Hospital Heart Center for treatment. She spent eight weeks in the hospital before we took her home to Iowa.

Two months later, Caroline developed a suspected recurrence of PVS and needed emergent care again in Boston.

My wife Maleia and I did everything we could to save Caroline’s life. Maleia joined Caroline in the medical transport, and our race against the clock began. Caroline’s first flight had gone very smoothly, but this one would be different.

About 45 minutes after takeoff, something with Caroline changed. The flight nurses weren’t exactly sure what had happened, but they knew they needed help — fast. Caroline’s blood oxygen levels were decreasing, and her carbon dioxide levels were rising, both of which are very dangerous. She wasn’t responding to the ventilator anymore, and the nurses were trying everything to keep her stable. The flight team desperately needed guidance.


Life-saving help from afar

What is PVS?
PVS is a rare cardiac disease — the veins that return blood to the left side of the heart accumulate cells called myofibroblasts that decrease blood return. Ten years ago, this disease was considered universally fatal.  A clinical protocol developed by the Boston Children’s Hospital Heart Center’s Pulmonary Vein Stenosis Program has improved survival for children with PVS.

They called the Boston Children’s cardiac intensive care unit (CICU) to speak with the doctor on call. It was Dr. John Kheir.

Kheir might know Caroline as well as her primary pediatrician; he had cared for her the first time she was in Boston, managing her in the cardiac intensive care unit CICU while she underwent open-heart surgery and two cardiac catheterizations.

When the flight nurses called Boston Children’s, they realized the satellite phone didn’t work in the passenger area of the plane, so they couldn’t speak directly with Kheir. He ended up talking to the pilot, who then relayed questions back to the medical flight crew. The medical flight crew reported back to the pilot. The pilot relayed information from the medical flight crew to Kheir.

Kheir worked with the flight crew to confirm the sedation medications Caroline was receiving and her level of sedation. Together, they reviewed Caroline’s arterial blood gas results (high pCO2, low pO2, poor oxygen saturation) and the ventilator settings.

Kheir told the crew to keep using the bag-mask device to ventilate Caroline instead of the mechanical ventilator. And he made two other key recommendations.

One was to start Caroline on dopamine, which is a cardiac medication that improves the quality of heart contractions. The second was to fly at a lower altitude to decrease overall cabin pressure. They had been flying at around 24,000 feet, but Kheir had them drop below 10,000.

Caroline-Lake-PVS-looking-at-camera-2A happy ending

With Kheir’s guidance, the flight team stabilized Caroline, and her oxygen saturation improved. Kheir also mobilized the Boston Children’s Hospital CICU ambulance to meet the airplane at Boston Logan. The Critical Transport Team spent 30 minutes on the tarmac assessing Caroline, further stabilizing her and then getting her safely to the CICU.

It still amazes me that while Kheir was on call in the CICU, responsible for at least 20 very sick children, he was on a phone helping our daughter, who was over 1,000 miles away, and trying desperately to bring her to Boston alive. I’m a physician, and it brings tears to my eyes to think about what Kheir did for my family that night. It was nothing short of heroic.

About the blogger: Dr. Doug Lake and Maleia Lake have had four children, three of whom are thriving girls. They live in Ames, Iowa.

Learn more about the Boston Children’s Pulmonary Vein Stenosis Program.