At some point in their career, physicians may need to have that difficult conversation with a patient’s family members: despite a successful resuscitation, their loved one has experienced irreversible brain damage.
It’s a conversation Dr. Robert Schultz knows all too well.
“Giving people bad news is the most horrible part of my job as a heart surgery resident,” Dr. Schultz said. “While it’s a privilege to be there to support people in such a difficult time, it’s hard, because things are beyond our control. If you can’t get enough blood flow to the brain during heart surgery, there’s nothing you can do.”
Techniques that cool the brain while the heart is stopped have been used in the cardiac operating room for decades. Hypothermia induced during surgery protects the brain by reducing the rate of oxygen consumption. However, these cooling practices can promote bleeding, and in turn, affect patient outcomes.
Dr. Schultz’s experience as an EMT and volunteer firefighter led him to pursue medicine, and in medical school he recognized his passion for heart surgery. He now works at the Libin Cardiovascular Institute of Alberta.
All his experiences—professional and personal—inspired Dr. Schultz to explore how technology might help improve patient outcomes.
Designing a ‘cooler’ solution
Dr. Schultz created a specialized central venous catheter that administers fluids through an existing IV line to achieve targeted, deep and rapid cooling of the brain. Aptly named after the Greek god of the north wind and winter, the Boreas Central Line (BCL) brings this cooling technique from the operating room to the bedside.
Because the BCL provides targeted, deep cooling while maintaining normothermia in the body, the risk of bleeding is prevented. And just like an airbag protects drivers, the BCL device is equipped with an emergency balloon that cools for neuroprotection in case of emergency.
Dr. Schultz knew that his innovation could prevent brain damage during cardiac surgery. He also knew bringing the BCL from conception to reality would be an exhaustive process.
Fresh program, fresh perspective
Indispensable to BCL’s creation was Dr. Schultz’s time studying translational medicine, a relatively new field. He recently completed his master’s from the University of California San Francisco and the University of California Berkeley.
“Working in a multidisciplinary team at UC Berkeley and UCSF was invaluable,” Dr. Schultz said. “Our team members came from all walks of life—engineers, business people, lawyers, and surgeons.” It was an eclectic mix that brought together a rich array of thoughts and ideas.
Based in experiential learning, translational medicine covers a wide range of activities, from the conception of an idea to advanced clinical testing and the development of a new medical technology or drug.
The heart of the MTM program at UC Berkeley and UCSF is practical learning in small group projects. Working in teams, students go through various steps that include needs assessment and prototype development.
At the core of translational medicine is design thinking. Defined as ‘a process for creative problem solving,’ design thinking focuses on the people that will benefit from what’s being designed―whether it’s a product, service or process. It matches what is technologically feasible with what’s needed from a human point of view.
The human-focused approach resonated intuitively with Dr. Schultz. “To me, it was a natural fit with my experience, and with being patient-centred.”
The data that led to a new perspective
Dr. Schultz mined the data and discovered that using the BCL in thrombectomy—removal of blood clots inside an artery or vein—while a valuable procedure in stroke care, could save twice as many more lives in a stroke situation. This provided a new perspective.
With the data showing that 1 in 6 people worldwide are affected by stroke in their lifetime, he was encouraged to explore the potential of the BCL device. Consulting with neurosurgery professionals became part of the process.
If at first you don’t succeed…
The testing phase challenged the team to think differently. With 20 people—including experienced emergency physicians—crowded into one room, the BCL device was tested on a CPR doll. Initial results were less than promising: while the cooling was effective, users encountered difficulty inserting the catheter and couldn’t put too much fluid in at one time.
“That was a difficult piece of feedback to test, and it’s hard not to have your doubts,” said Dr. Schultz, “but troubleshooting is at the heart of the process, after all.”
He and his colleagues went back to the lab, made modifications, and just four days later presented the revised device in the same situation. “The second time, the catheter went in smoothly and easily,” he reported. “I thought, ‘what’s the big deal? That wasn’t so hard to fix.’ Design thinking definitely improved and sped up our process.”
Dr. Schultz feels empowered by his experience with translational medicine. He believes the BCL will improve quality of life for cardiac arrest survivors, with the goal of reducing the chance of brain damage post-cardiac arrest from 38% to 3%. “Our next steps are to complete the safety checks and apply for FDA approval,” he said. “We want to understand where the BCL will provide the most benefit.”
As an experienced EMT professional, Dr. Schultz thinks that using the BCL in emergency situations—for example, in an ambulance on the way to hospital—has the potential to prevent brain damage in cardiac arrest, cardiac surgery and stroke cases.
And, it may even mean fewer of those difficult conversations.