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Sidra performs lifesaving airway stent procedure on Omani patient

Sidra performs lifesaving airway
stent procedure on Omani patient

Tribune News Network
Maryam, a four-year-old girl living in Oman, suffered catastrophic internal injuries following a blunt trauma to her chest after an accident and developed life-threatening airway problems. She required a highly specialised interventional airway procedure to preserve and save her lung, a procedure not available in Oman.
Worldwide, there are only a select number of hospitals with a combination of Cardiac Intensive Care Units (CICU) and interventional radiology expertise that specialise in paediatric airway (bronchial stent) interventions. Sidra Medicine, a QF entity, is one of the few hospitals with a CICU that provides support for infants and children with congenital or acquired heart disease. The hospital is also the only one in the Middle East with an advanced intra-operative imaging suite (IMRIS) supported by adult and paediatric interventional radiologists and a paediatric cardiac anaesthesia team to ensure patient safe outcomes.
Maryam who suffered severe injuries to her left lung, liver and diaphragm as well as a broken arm was being cared for at the Paediatric Intensive Care Unit (PICU) in Sultan Qaboos University Hospital in Oman. Despite having undergone multiple complex surgeries, and with the surgeons in Oman repairing the torn bronchus in Maryam’s lung, her injuries meant that she needed to breathe through a tube (tracheostomy) connected directly to her trachea.
Despite being on a ventilator, Maryam’s left lung kept collapsing due to inadequate air entry as it was not strong enough to remain open on its own and for her to breathe normally. This meant that there was a significant risk of losing her left lung. In order to preserve it, the PICU team in Oman coordinated with Sidra Medicine to bring Maryam to Qatar for the highly specialised airway stent procedure.
“It was critical to bring Maryam urgently to Qatar to save her lung. What was even more challenging was the fact that it happened during the pandemic – we had to put all stops in place to ensure a safe patient transfer,” said Prof Ziyad M Hijazi, acting chief medical officer and executive chair of Paediatric Medicine at Sidra Medicine.
“We had our team of international patient programme experts and medical specialists coordinating the entire process, especially Dr Andrew Durward, CICU attending physician, who carefully oversaw the details of the transfer with the team in Oman. Along with Dr Walid Mubarak, Interventional Radiology Attending, both physicians planned the details of Maryam’s stent placement using imaging sent from Oman,” continued Prof Hijazi.
Maryam was transferred to Qatar on a specially chartered flight, with her father and aunt and was escorted by a paediatric medical team from Oman. She was immediately transported from Hamad International Airport to Sidra Medicine via ambulance, where she was accompanied by Dr Andrew Durward, Attending Physician at Sidra Medicine’s CICU unit who is one of the few physicians specializing in airway interventions and brought the technology to Sidra Medicine from his previous stint at Evelina Children’s Hospital in London. Dr Walid Mubarak and Dr Ashley Robinson, both of whom are considered dedicated paediatric interventional radiologists (less than 100 worldwide) and experts in image guided interventions, planned the procedure with Dr Durward.
Maryam’s procedure was planned as a multi-modality, multidisciplinary approach with her care at Sidra Medicine involving life-saving support from the CICU unit, interventional radiology, pulmonology, ENT and paediatric anaesthesia.
To improve the outcome of the procedure, Maryam’s surgery took place in Sidra Medicine’s state-of-the-art IMRIS hybrid operating theater, which features intraoperative imaging capabilities, including a moveable intraoperative MRI and capacity to run highly complex interventional radiology procedures. Her procedure involved the use of CAT scan, fluoroscopy and bronchoscopy working together at the same time to insert the stent under direct and indirect visualization.
The procedure, which took three hours, featured Dr Durward and Dr Mubarak placing a biodegradable stent on the left side of Maryam’s airway. The customised stent, which is 20 mm long and 5 mm wide, was placed to keep her airway open and for her to make full use of both her lungs.
“This is a highly specialized procedure, as the stent needs to be positioned very carefully and has to fit the airway exactly in order to avoid any complications. It is performed by only a handful of airway specialists around the world, in addition to the fact that there are only a few centers that can perform paediatric airway stents,” said Dr Andrew Durward, attending physician at Sidra Medicine’s CICU unit.
Maryam’s recovery was very swift, as her breathing improved on the very same day following her procedure. Her stent will biodegrade in three months and is not expected to leave any damage to her airway. She is expected back at Sidra Medicine in three months, for a follow up consultation and a replacement stent with a view of seeing how her airway recovers over time.
Talal Al Balushi, Maryam’s father, said: “My family and I are truly grateful for the support we received every step of the way. To see Maryam being able to breathe normally just hours after her procedure has been so reassuring. Alhamdulillah that my daughter’s life has been saved and for the wonderful cooperation between both our governments and the medical teams in Oman and Qatar. Thank you!”