Machine has saved lives of 1,000 children at Riley hospital
INDIANAPOLIS (AP) - One moment Millie was sitting up in her hospital bed, chattering away to her parents, recovering from what was supposed to be routine heart surgery a day earlier. The next moment, the toddler collapsed, not breathing.
The doctors and nurses at Riley Hospital for Children worked frantically, performing CPR for about an hour. They did not know why Millie had suddenly passed out, but they did know what they had to do: hook her up to a machine that could do the work of her heart and lungs, buying them time, precious time.
It was not the first time her mother, Candra Modesitt of Petersburg, Indiana, feared for her daughter.
When Modesitt was 16 weeks pregnant, her obstetrician referred her to Indianapolis for monitoring after tests revealed some irregularities. Millie's heart was beating slower than normal, the top chambers not communicating well with the lower ones. To survive, she would need a pacemaker soon after birth.
On May 20, 2016 Millie's mother, Candra Modesitt, underwent an emergency C-section. Between four to six hours later, Millie was whisked away for surgery, her mother said.
Because she weighed a mere four pounds, 12 ounces, doctors implanted the tiniest pacemaker available, knowing that eventually she'd need an upgrade.
"Just being that the pacemaker was so small, the battery wasn't going to last forever," said Dr. Mark Ayers, a pediatric cardiologist at Riley Hospital for Children who helped take care of Millie.
A few months before Millie's third birthday, she came to Riley from her home near Evansville, for what was expected to be a four-day stay. She would undergo surgery to replace her pacemaker and repair a hole in her heart, both pretty routine procedures, Ayers said.
The night after the surgery and the next morning, Millie appeared to be recovering well, Modesitt said. Then she suddenly went unresponsive.
"Nobody knew at the time what happened. . She was literally sitting up, talking to us like a normal kid," she said. "Then she coded."
A medical team swooped in to keep her alive, attaching her to a machine called ECMO, or extracorporeal membrane oxygenation. The machine drains the body's blood from the vein and does the work of the heart and lungs, taking out the carbon dioxide and adding the oxygen, and then returns the blood to the body.
Similar to dialysis for the kidneys or the heart lung bypass machine used during cardiac surgery, ECMO kept Millie's heart working for four days.
"It was scary, that that was what was keeping her alive," Modesitt said.
ECMO can only serve as a temporary fix, however, because it comes with side effects, such as the risk of a blood clot. Typically doctors only use it for a few days. "It's used when you know there's something reversible that will improve. You hope it will be as short as possible," Ayers said.
The machine requires a person manning it at all times, said Gail Hocutt, Riley's ECMO program manager.
After a few days, doctors were able to diagnose the problem, and perform a follow-up surgery to correct a malfunction of Millie's pacemaker leads. Once doctors repaired the problem, Millie's heart could perform on its own.
"I'm thankful for it because it gave us the time we needed," Modesitt said.
But a four-day hospital stay stretched into 10 weeks as Millie's lungs healed and doctors attended to two blood clots that formed in her heart, a side effect of ECMO.
The hospital has nine machines for both neonates and older kids like Millie, ensuring that there are sufficient backups should one machine fail. At any one time, four to five patients can be on the machine.
Usually the hospital has about 30 patients a year on the device, which the hospital has used for the past three decades. Last year was a banner year with 48, Hocutt said.
Each patient who uses the machine gets a t-shirt with his or her number of the back. Millie, whose full name is Amelia, received a t-shirt that bears her number - a big black 1,000.
Millie is the 1,000th patient at Riley Hospital for Children treated with ECMO.
For Modesitt, Millie's place in line proved comforting.
"I was kind of glad we were in the bigger numbers so everyone knows how to use the machine, but you're saddened because 1,000 people needed it before her," she said.
Because many of the patients who require ECMO are newborns, Millie's t-shirt is sized for a six-month-old. Her mother plans to turn it into a t-shirt quilt.
Millie has an affinity for the soft garment, pressing it to her cheek and chirping out the many colors on it, orange! blue! and purple!
"It's like soccer," she said, comparing it to her sports outfit, as she visited Riley for a follow-up appointment.
While Millie went home at the beginning of May, she remained on twice daily shots of a blood thinner to prevent further clots. Now she's back home, swinging on the airplane swing her grandfather made her, playing with her big brother Mylz and her dog Penny, and looking forward to starting preschool in August.
Millie had one goal for the appointment: "No more shots, no more shots."
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Source: The Indianapolis Star
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Information from: The Indianapolis Star, http://www.indystar.com