This Thanksgiving, Toddler is Extra Thankful for Intensive Care Team at Lucile Packard Children’s Hospital Stanford

Care teams at Lucile Packard Children’s Hospital at Stanford are accustomed to seeing critically ill children defy the odds, but even the most experienced doctors are still talking about the remarkable recovery of a 2-year-old boy named Dominic Vega.

When Dominic was battling to survive a series of life-threatening setbacks last spring, including a remarkable 41 days on an artificial heart-lung machine, it seemed like every day could be his last. Now, the brave little boy is back home in Chico, Calif., getting ready for a big Thanksgiving. “I can’t think of a better symbol of giving thanks than Dominic,” said Gregory Hammer, MD, anesthesiologist and critical care specialist at Packard Children’s and a professor of anesthesiology and pediatrics at the Stanford School of Medicine, who called the case “one of our biggest saves ever.” It all started on New Year’s Day this year when he began having trouble breathing and parents Jesse and Jessica rushed him to a hospital. He was diagnosed with a severe case of respiratory syncytial virus (RSV) and admitted for treatment. His condition kept getting worse. While the RSV eventually cleared up, his lungs were failing. An ambulance hurried him to the Pediatric Intensive Care Unit (PICU) at Packard Children’s. Unfortunately, his condition rapidly declined. Drastic measures would be needed.

That meant hooking Dominic up to a heart-lung bypass called an extracorporeal membrane oxygenation machine, or ECMO, which does the work of pumping blood for the heart and lungs. ECMO therapy required that all of the blood from his body be drained from his neck through a tube to a filtering machine on the floor, and then pumped back into his aorta. “Sitting there and watching them draw all the blood out of him was the most difficult thing for a mother,” Jessica said. ECMO gives the heart and lungs a chance to rest, but the risks are huge. The potential side effects include blood clots, bleeding, infection and air bubbles. If anything goes wrong, the result can be catastrophic. Dozens of staff coordinated Dominic’s care and treated any complications. He needed X-rays twice daily, multiple bronchoscopies, numerous tubes inserted into his chest, pain killers, blood thinners, antibiotics and even sedatives.

“He was at risk for getting an overwhelming infection or developing other major problems, like a stroke or bleeding in his lungs,’’ recalled Hammer, who also said the risks associated with ECMO increase as time goes by. “The chances of Dominic being alive on ECMO 41 days later would be less than 10 percent.” How much longer could he survive? Both leaving him on ECMO and taking him off posed great risks. Then, after 33 days, he started bleeding profoundly in his lungs. “There wasn’t much hope,” recalled David Cornfield, MD, director of critical care medicine at Packard Children’s and the Anne T. and Robert M. Bass Professor in Pediatric Pulmonary Medicine at the School of Medicine. “The treatment saving his life also was causing recurring bleeding in his lungs.”

Then, while conducting regular bronchoscopies to clear airway clots, Cornfield and team got the idea to treat Dominic with an aerosol version of Factor VII, an engineered compound designed to quickly stop bleeding. Factor VII is commonly administered intravenously, and Cornfield believes Dominic may be the first patient on ECMO to receive it through a nebulizer. By treating just the airways with the compound, they were able to minimize its side effects and help stop the lung bleeding with minimal clotting. With the airways unobstructed, Dominic would have a far better chance of breathing on his own after being taken off ECMO.

Jesse and Jessica, clothed in surgical caps and gowns, were allowed in their son’s Pediatric Intensive Care Unit room as the surgeons began the delicate procedure to remove the tubes from Dominic’s neck and aorta as he was taken off ECMO. “We were waiting for everything to start dropping and it didn’t happen,’’ recalled Jesse, Dominic’s dad. “It was a complete shock. He was able to maintain his breathing.”

In the two months that followed, doctors gradually weaned Dominic off of all respiratory support. Later, after five months in hospital beds, he had to learn how to stand up, move his hands and walk. Now, though he will always have some scarring in his lungs, he is healing nicely – and ready for Thanksgiving and Christmas back home in Chico. “If you saw him now, you would have no idea what he went through,” Jessica said. “He had the best care possible.”

Cornfield said there were easily 150 people who played a direct role in helping save Dominic’s life. “The fact that we could bring so much expertise, focus and dedication to one incredibly ill child for such a sustained period of time is a wonderful testament to the work that goes on here on a daily basis.” “We learned a lot from Dominic about the power of hope,” said Cornfield, who plans a toast to Dominic during Thanksgiving dinner. “He taught us that until the very last moment that we should do everything possible for a full cure, and for this we give thanks.”

Authors

Media contact:
Robert Dicks
rdicks@stanfordchildrens.org