Technology, teamwork and telemedicine to the rescue

DuvallMelodyAs a critical care physician, there’s not much Boston Children’s Hospital’s Melody Duvall, MD, PhD, hasn’t seen, but even she is surprised by a case from time to time.

“Cameron Shearing’s story is truly amazing,” she says. “It’s a real testament to the power of technology and teamwork in crisis.”

Last December, two-year-old Cameron’s airway suddenly became blocked by a chocolate-covered pretzel he was eating. It didn’t take long before tiny bits of pretzel found their way into his lungs, complicating his breathing even further. Despite the mounting snowstorm outside, Cameron was quickly rushed to the South Shore Hospital Pediatric Emergency Department (ED), which is staffed by Boston Children’s physicians and South Shore Hospital providers. But by the time Cameron arrived, he wasn’t breathing—he didn’t have much time.

The odds of a good outcome were not high. Pretzel is one of the worst foods to have lodged in your throat because the tiny pieces can block multiple small airways, and the salt topping can very quickly irritate the throat and lungs, causing dangerous inflammation. At the South Shore Hospital ED, doctors rushed to Cameron’s aid, but treating the small child turned out to be a big issue.

“Cameron was one of the sickest patients I ever cared for as an emergency physician,” recalls Galina Lipton, MD, a Boston Children’s Department of Emergency Medicine doctor who staffs the South Shore emergency room. “I did everything I could within my scope of practice, but he needed the tools and expertise of pediatric subspecialists, and they were miles away at Boston Children’s.”

Telemedicine in action

cameron-shearing-with-Dr.-LiptonLipton and the South Shore team worked on Cameron for an hour, and managed to stabilize him with a breathing tube. But getting air into Cameron’s lungs was just the first step in his treatment. The delicate job of removing the pretzel bits from his airways would need to be performed by a pediatric or cardiothoracic surgeon using a specialized bronchoscope, neither of which was available at South Shore Hospital.

On most days, a child in Cameron’s condition would be transferred to a hospital like Boston Children’s because it has the required tools and staff to handle specialized pediatric cases. But the raging snowstorm made quick transport impossible. And because the pretzel Cameron had swallowed had already broken into small pieces and obstructed his airways in multiple locations, managing his care for the two to three hours it would take Boston Children’s Pediatric Critical Transport Team to arrive would be even more difficult.

“His entire cardiorespiratory system was at risk of collapse,” recalls Lipton. It was a dire situation and the South Shore Hospital team didn’t have the luxury of time.

Knowing she had to act, Lipton activated the TeleConnect service, a real-time video-conferencing platform that connects Boston Children’s to community hospital partners like South Shore Hospital. She requested consultation with the subspecialists on duty who had the expertise to help manage Cameron until the transport team arrived.

Care coordination

Lipton was patched through to Duvall and the two doctors video-conferenced, discussing how to fine-tune Cameron’s ventilator settings without overinflating his lungs.

doctors talking in scrubs“It was almost like having her in the room with us. She could see the monitors, review changes in his condition and consult with all of the providers in the room,” Lipton says. “Unlike a phone conference, I didn’t need to act as a middle man and relay information to other members of the treatment team. Things were happening in real time.”

As Duvall and Lipton expected, one of Cameron’s lungs soon collapsed, while the other over-expanded, pushing the South Shore Hospital team to the highest level of emergency medicine practice to keep him stable. But by 8:00 p.m., nearly three hours after Cameron arrived at South Shore Hospital, the medical transport crew arrived and Cameron was on his way to Boston Children’s.

The initial plan was to fish the pretzel out of Cameron’s lung via a specialized process called a bronchoscopy. But Cameron’s condition was precarious, and shortly after arrival the procedure was deemed too risky. He was rushed to the Intensive Care Unit where he spent the next two days, hooked up to an extracorporeal membrane oxygenation (ECMO)machine that kept his heart and lungs functioning for him, buying his surgeons the time they needed to extract the pretzel particles from his lungs.

“His doctors prepared us for the worst,” recalls his mother Nicole. “They told us he might not wake up, he may not walk or talk. It was devastating.”

But like the circumstances around his hospitalization, Cameron’s recovery turned out to be anything but ordinary. With the pretzel removed from his lungs, the toddler was weaned from ECMO and woke up a few days later speaking in clear, complete sentences without any apparent effect on his brain. He was weaned from the ventilator, treated with antibiotics and steroids and sent home just in time to celebrate Christmas with his family.

“It’s a story with a happy ending, thanks to the effort of everyone involved,” says Duvall. “From Cameron’s parents to the South Shore pediatric emergency department team to the pediatric critical care transport team to the intensive care team and surgeons, everyone played an important role in saving Cameron.”

Boston Children’s physicians work onsite with emergency physicians and nurses at many community hospital Emergency Departments in eastern Massachusetts. Click here to find us.