Eight-Minute Gamble With Death

Press, Volume CVI, Issue 31143, 20 August 1966, Page 12

Eight-Minute Gamble With Death

<Ry

PETER MAHONEY

in the “Sydney Morning Herald")

TT was 1 p.m. A surgeon had electric- * ally shocked the woman’s heart, stilling it. On the oscillograph screen, the little light that recorded brainwaves had flickered out. The woman was cold. She looked dead.

A neuro-surgeon in a green gown stood beside her. He peered and probed through a Sin oval hole he had drilled and sawn in her head. Two inches into the brain he found what he sought. It was a large “bubble" in the middle cerebral artery. The surgeon picked up a strand of black silk. Looking through the hole, he knotted it around the artery and pulled tight. A theatre sister passed him forceps. He fitted a V-shaped little silver cup to the end. He slid the V over the bubble and squeezed it flat. He repeated both processes—more silk, another clip. Then he put down the forceps. signalled the cardiac team and stepped back. The

low rumble of the heart-lung machine recommenced. It was 1.8 p.m. Surgery won a gamble with death in those eight minutes. Doctors, sisters, technical people crowded Sydney’s Prince Henry Hospital operating theatre. They sweated in caps and masks and canvas overshoes under hot lights. Yet the woman on the table remained at 48 degrees F. It had taken most of the morning to get her into this state. A refrigerated liquid ran through two rubber blankets that enveloped her. Then her blood had coursed through tubes in a tank of icy water. Finally a doctor guided a thermometer probe deep into her brain. “She’s ready,” he said when its reading matched those from other parts of her body. The bubble the doctor clamped was an aneurysm, a weakness in the artery wall that allowed a ballooning

-effect. It had bled two weeks before. The 25-year-old housewife had crawled partly paralysed to a neighbour for help. X-rays located the aneurysm, the biggest the Prince Henry team had seen. From an artery one-eighth-inch wide it protruded in a half-inch by one quarter-inch hump. It seemed about to burst. The result would have been fatal. The doctors calculated the risk and took it. Essential Delay They could have operated at once. But past experience counselled against the scalpel’s use within seven days of a stroke. The ideal time would be between a week and a fortnight, but no longer because another hemorrhage would probably have followed the first. Her agonising headaches dulled by drugs, the woman lay 12 days in a darkened room, forbidden the slightest movement. Poring over angiogram pictures, brain surgeons noted another risk. The aneurysm was so placed and so shaped that, had it burst during a normal operation, the patient would have been left without speech and paralysed down one side.

They decided on profound hypothermia, a new technique made possible by the heartlung machine. It is a technique that uses the principles of hibernation to induce a state of “living death” for up to an hour. The circulation would be stopped. Then there could be no harmful bleeding. Planning the operation took more than a week. It took Sisters Rita Stahl, Sheila Walters and Barbara Ross a week to prepare the theatre equipment. Mr S. Yarrow, a veteran of 950 by-pass operations at Auckland’s Green Lane Hospital took several days getting the heart-lung machine organised. Experienced Team Cardiac specialists of the hospital’s division of cardiopulmonary surgery consulted with the neuro-surgeons. The Red Cross blood bank called in donors to supply eight pints of a rare blood type. Pathologists, electronics experts, nurses were drilled. Jackhammers chattering beneath the theatre were stilled for the day-long drama. The canteen sent up tea and sandwiches. A barber shaved the woman’s head at 6.30 a.m. An hour later she was put to sleep with pentothal and paralysed by the South American herbal drug, curare. She stopped breathing. The anaethetist took over. His pumping into her lungs of nitrous oxide, halothane and oxygen was to go on until 4.30 p.m. The operating theatre was filling. Measuring and recording equipment lined the walls. No fewer than 16 experts in six or seven fields would huddle around the table soon. Nurses had erected a partition to divide zones allotted to the heart and brain teams. Space Crowded The table, the floor, became a jumble of wires and tubes as electrodes and needles were pushed, 13 in all, under the skin of the woman’s limbs, head and body. Two anaesthetists stood at her feet with their machine. There was no room anywhere else.

The heart-lung machine purred. A surgeon made an incision in the right groin. He exposed the main femoral artery and vein, clipped and snipped them. Into the vein he pushed a three-eighth inch plastic tube, into the artery a steel one. On a nod from the man in charge of the by-pass machine, one of the anaesthetists stepped forward and injected heparin, an anti-coagulant. A technical man passed a 10ft tube looped to the machine to the cardiac surgeon. Blood diluted with dextrose and other fluids ran as he cut it through and joined the ends to those jutting from the patient. Heart Stopped The patient s blood coursed through the machine. Dials and flashing lights recorded changes in muscle, rectal, oesophagal temperatures as it cooled. The clock on the pastel green wall showed 11.45 a.m. The rubber blankets had brought the blood down a few degrees from its normal 99 When it sank to 82, the heart surgeon pressed a switch. A 240-volt shock stopped the heart. The machine took over its job. Time passed. A scout nurse hurried from the theatre. She carried a syringe containing a blood sample for pathological tests. Temperature Down The neuro-surgery team came, three doctors and a sister. The leader drilled five quarter-inch holes on the left side of the patient’s head in an oval pattern. He passed a wire saw through the holes and carved out a bone disc, exposing the brain’s covering. The work took most of an hour.

Now the blood temperature was dropping more slowly. Muttered voices relayed readings of pressure and the electro-cardiogram. A telephone rang in the office out-

side. A sister came in with a message from the pathologist. The surgeon running the machine made a minor adjustment to oxygenating equipment.

By 12.30. the body had almost reached the level at which people die of exposure. Clinically Dead The chief brain-surgeon checked his thermometer probe. He nodded to the men down the. table. The specialist at the controls threw a switch, i Its subdued throbbing stopped. So did the circulation. Eyes swung to a stop-watch on the heart-lung machine, to the sweep hand of the wall clock. The woman was dead in some clinical respects. Her chest rose and fell at fourminute intervals as the anaesthetist squeezed his gas-filled rubber bag. Scissors in hand, the brainsurgeon was at work. Under normal conditions the brain cannot survive undamaged if deprived of blood and oxygen beyond three minutes. Chilled, its requirements are less. A hibernating animal lives months with little air. “Isn’t It Cold?" The first operation of its type in Australia, done by the same team, took 43 minutes for this critical intra-cranial part. This was the ninth. And it took eight minutes. The aneurysm flattened the machine began refilling the woman’s blood vessels. The morning's cycle now took place in reverse. They restarted the heart with another shock when the blood warmed enough. The brain surgeon replaced the bone flap. His part of the exercise was finished. By 2.15 p.m. the blood tern perature was normal. But it had not warmed the body through. The last dressing went on at 4.15 p.m. It was all over. The anaesthetist put down his bellows. The woman awoke drowsily “Thank you doctor,” she said “Isn’t it cold?”