Photo: Ford, Brad
On the Saturday before Easter, Hailee and Quaid Busk of Central Oregon were enjoying the weekend with their three children — 8-month-old baby girl, Blakely, and 5-year-old twins, Brody and Jewel. But the day took a terrifying turn when Blakely suddenly screamed and collapsed in Hailee’s arms while she was feeding. She quickly lost all color in her face and began going in and out of consciousness.
“It was very traumatic,” Hailee recalled. “We rushed her to the emergency room and they did some tests but weren’t sure what was going on. She had another episode in the hospital, and her oxygen levels started to drop. That’s when the doctors decided we needed to get over to Doernbecher right away.”
The PANDA Team, a group of clinicians specially trained in critical care transport, arrived within the hour and took Blakely in a Life Flight helicopter to Oregon Health & Science University Doernbecher Children’s Hospital. It was all hands on deck from the second the Busks touched down.
An ultrasound and CT scan confirmed Blakely was facing a condition known as an abdominal aortic aneurysm, often referred to as “AAA,” which creates a bulge or swelling on the lower part of the aorta that runs through the belly area.
The condition, usually seen in men 65 and older is exceptionally rare in children.
“When we saw those results, we were all shocked. It’s certainly not something you see every day,” said Mubeen A. Jafri, M.D., head of pediatric surgery at OHSU Doernbecher and a lead provider in Blakely’s care. “Treating something this rare requires an extremely risky procedure, which has only been done by a small handful of surgeons across the country.”
The aorta is the biggest artery in the body and carries blood from the heart to the rest of the organs. An abdominal aortic aneurysm that ruptures can cause life-threatening bleeding, and has an extremely high mortality rate — about 85% — without surgical intervention. The condition is especially dire in an infant, because children, unlike adults, are unable to tolerate blood loss.
A collaborative care effort
When the Busks arrived at OHSU, Blakely’s right leg was blue and swollen because her aorta had ruptured into her iliac veins, the blood vessels in the pelvis. Jafri and his team needed to act quickly.
With the rich combination of pediatric, cardiac and vascular surgery specialties available at OHSU — let alone the high risk of transporting a patient in this condition — surgeons knew OHSU was the best place for Blakely to receive life-saving care.
“We were very confident we could bring the expertise and collaborative team approach needed for this procedure to be successful,” Jafri said. “We knew what we needed to do.”
Co-leading Blakely’s care team was Sherene Shalhub, M.D., M.P.H., head of Vascular and Endovascular Surgery at OHSU. Shalhub emphasized that such a high-risk procedure for an extremely rare condition required meticulous preparation and teamwork.
“We considered what could go wrong, all the pitfalls of this operation, and worked together to determine how to prepare ahead of time to manage that,” Shalhub said. “It was really a beautiful collaboration, and everyone brought their A game. We all took pieces from our collective experiences from other forms of disease to figure out how we could care for Blakely.”
Understanding the complicated nature of Blakely’s condition, the Busks also knew how important it would be to have expertise from OHSU’s various specialties and appreciated the collaborative spirit of their care team.
“I told them not to sugarcoat things. They were honest that they’d never seen this at their hospital before. As a mother, that was terrifying, but we had to hear it,” Hailee said. “But the way the team collaborated with different specialties within the hospital and with doctors and surgeons from all over the country was incredible. They were so confident and quick to act.”
Photo: Ford, Brad
During Blakely’s procedure, there were upward of 10 specialists in the operating room, including two pediatric surgeons, Jafri and Devin Halleran, M.D.; three vascular surgeons, Shalhub, Cherrie Z. Abraham, M.D., and Amir F. Azarbal, M.D.; a pediatric cardiac surgeon, Ashok Muralidaran, M.D.; as well as an anesthesiologist, three nurses and countless others who were involved in critical pre-surgery preparation.
The procedure itself was extremely risky and complex. To manage an abdominal aortic aneurysm in an adult patient, surgeons often insert a stent in the aorta, which allows the area to expand and blood to flow through. However, these devices are much too large to use in an infant like Blakely. The team instead used precise surgical methods and medical materials to create a solution for immediate, effective stabilization and resumption of blood flow.
Despite the chaos of the day, Hailee remembers how supported she and her husband felt. “The team gave us a pager so they could send us hourly updates throughout the operation. She would send me messages like, ‘Blakely is stable and everything is going to plan,’ and that just meant so much to us.”
After a seven long hours, there was a collective sigh of relief when they received the news that the operation was successful.
“When Sherene came and told us, I broke down crying in her arms,” Hailee said. “They really did it — they saved her life — and we just can’t say enough positive things about our experience.”
Lifelong care
The Busks couldn’t have imagined what they’d have to endure that Easter Sunday, but thanks to the care they received at OHSU, they were able to return home safely with their baby girl the very next Sunday. Several weeks later, she was eating, sleeping and smiling like herself again.
When reflecting on that day, Shalhub calls it nothing short of a miracle: “It went so smoothly for such a complex, rare, difficult problem. I really do feel like we were blessed that day.”
To ensure Blakely fully recovers and is able to live a long, healthy life, she’ll receive ongoing follow-up care with Shalhub, Jafri and their teams. Depending on the outcomes and development of her condition, she may require additional vascular surgeries down the road.
Blakely and the Busk family will be in good hands: OHSU Doernbecher Children’s Hospital offers the broadest spectrum of pediatric health services in the region. Importantly, the proximity of OHSU’s hospitals ensures pediatric and adult specialists work closely to ensure the unique needs of patients with complex cardiac and vascular conditions throughout their lifespan, providing a seamless transition in care from childhood through adulthood.
“It’s lifelong relationship now,” Shalhub said, “and we’re all excited to care for her as she grows up.”
Source: OHSU