Doctors save woman after pulmonary embolism

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Award winning doctors: Dr. Michael Nicholas (from left) and Dr. Michael Nuyles, of Franciscan St. Margaret Health - Dyer, were recognized for saving the life of a woman who suffered a pulmonary embolism. The physicians were alerted to the situation by Dr. David Braunstein, who made the diagnosis. | Supplied photo

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Having limited options as they treated a patient who faced almost certain death if a solution to her problem

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wasn’t quickly found, two Franciscan St. Margaret Health-Dyer physicians had to think fast.

Dr. Michael Nicholas and Dr. Michael R. Nuyles not only saved the elderly woman’s life, but their answer turned out to be only the fourth time the procedure they employed had been done in the world. It earned not only the gratitude of the patient and her family, but international recognition at a recent Transcather Cardiovascular Therapeutics conference, where it received a Best Challenging Case award.

Nuyles presented the case, titled Massive Pulmonary Embolism Treatment with Thrombolysis via Local Drug Delivery Catheter. He since has presented it at a conference in Chicago.

The patient had a massive pulmonary embolism – a blood clot in her lung that had traveled from her leg — that obstructed blood flow through the lungs and threatened her heart function.

Balloon solution

After being alerted to the situation by Dr. David Braunstein, who initially saw the patient and made the diagnosis, Nicholas said it was obvious “something had to be done quickly” to dissolve the clot and improve blood flow immediately.

“We had used this ClearWay (manufactured by Atrium Medical Co.), drug delivery balloon for other procedures, usually for the legs and heart, but never in the lungs. I thought, ‘why not try it?’ We had familiarity with it so decided, after consulting with the hospital and the patient and getting approval, to give it a shot and it worked,” Nicholas said.

Nicholas, a doctor of osteopathic medicine who has been in practice and with St. Margaret Health since 1985, and is its interventional cardiology program director, said the team quickly “did its homework” and learned the procedure previously had been done by interventional radiologists elsewhere. He consulted with them before performing it.

“This particular balloon gently infuses a drug within the clot to break it up” he said.

The procedure has been performed approximately 40 times since, according to the company, which also confirmed the one done by the St. Margaret physicians was the fourth.

The advantage of using ClearWay to treat critical pulmonary embolism is in its atraumatic local drug delivery, which can help restore oxygen saturation by rapid resolution of a clot with less procedure time and lower drug volumes necessary to resolve the clot, compared to traditional systemic IV drug dosing. That can translate into lower health care costs and better outcomes, the company said.

Team effort

Nuyles, who has been a doctor of osteopathic medicine for eight years and an interventional cardiology fellow at St. Margaret Health for five of those, said presenting the case (twice, so far) before the world’s top cardiologists, has been a thrill, but helping the patient was most satisfying.

“She was doing poorly and starting to crash. I am very happy she was able to be helped and recover.”

Nicholas credited the St. Margaret staff’s teamwork and the hospital for having the means to deal with the case.

“We had the right personnel and the right equipment,” he said. “It was a win-win for everyone. This shows that patients do not have to travel to university hospitals to get the best treatment.”

Provided by Franciscan St. Margaret Health