Don Fournier zoomed across the frozen lake on a snowmobile, a blizzard swirling around him, air rushing past.
Going close to 100 mph, his sled slammed into a seawall.
The ride ended with a call to 911, and the race to save his life began.
Fortunately for Don, his trauma team used a new device designed in the battlefields of Iraq and Afghanistan to help patients suffering from massive bleeding.
He became the third patient at Spectrum Health Butterworth Hospital treated with the device, called an ER-REBOA, which temporarily halts blood flow to the lower part of the body.
The device—along with prompt medical care—made a life-saving difference for Don.
“I’m so happy to be here,” he said.
An ‘open-book pelvis’
Don’s injury occurred on the day of an annual winter party he and his wife, Lois, host in Mecosta, Michigan, on Round Lake, where they have a fifth-wheel travel trailer. They gather with friends, build a bonfire and play in the snow.
And they ride snowmobiles on the frozen lake.
Don, a 62-year-old retired truck driver, knows the lake well. That day, he had been riding snowmobiles all day. But somehow during that last ride, he lost his sense of direction.
He thought he was headed back to the bonfire, but instead was cruising in the opposite direction toward the far shore.
When the sled hit the wall, his body slammed into the handlebar. He flew over the top and landed between the trees.
His thigh bone splintered. Seven ribs and five vertebrae cracked. He punctured his lungs and cracked his pelvis.
The first responders identified him as a level 1 trauma case and took him by ambulance to the emergency department of Spectrum Health Butterworth Hospital, the only level 1 trauma center in West Michigan.
The trauma team assembled: surgeons, residents, nurses, radiology technicians, operating room staff, the intensive care unit staff, social workers and pastoral care.
“When the patient comes through that door, the entire team is prepared to care for that patient, so we can address life-threatening injuries very quickly,” said Alistair Chapman, MD, a Spectrum Health Medical Group critical care surgeon.
Historically, trauma specialists have talked about the importance of the “golden hour,” the time period in which they aim to address a patient’s injuries.
“Now we talk about the platinum 10 minutes,” Dr. Chapman said. “If a patient is hemorrhaging, their risk of mortality increases exponentially every 10 minutes.”
Don’s blood pressure had dropped from the scene of the accident, a possible sign of bleeding. The trauma team started a massive blood transfusion protocol and looked for internal bleeding. They investigated areas where a large amount of blood can pool—the chest, abdomen, pelvis and thighs.
The doctors found Don had an “open book pelvis.” The impact had cracked the normally curved pelvis, opening it like a book.
“When that happens, the volume of the pelvis increases substantially and you can lose a lot of blood,” Dr. Chapman said.
With the blood transfusions and a binder placed around the pelvis, Don’s blood pressure began to rise to a more normal level.
He had a CT scan, and then was taken to the operating room to repair his injuries. Dr. Chapman worked to put in a central line, as well as place a chest tube and a bronchoscopy.
“We put a camera in his belly to make sure he didn’t have injuries to any of his intestines,” he said.
Seth Gengler, DO, a Spectrum Health Medical Group orthopedic trauma surgeon, began to put an external fixation device on the pelvis to hold it together.
“Halfway into the procedure, (Don) developed extremely low blood pressure, despite the fact we were continuing to give him blood,” Dr. Chapman said.
The surgeons decided to use the REBOA, a device created by Prytime Medical.
Entering through the left femoral artery, they threaded a balloon into Don’s aorta—the main vessel that carries oxygenated blood from the heart to the rest of the body. When it reached the section of the aorta just above the pelvis, they inflated the balloon, bringing blood flow to a halt.
“Once you inflate the balloon, the timer starts,” Dr. Chapman said. “Anything below the balloon is not getting blood supply or oxygen.”
Placing the REBOA balloon buys time for the surgeons to find the source of bleeding and correct it. The amount of time depends on the balloon’s placement.
When it’s placed in the pelvic area, as it was for Don, the medical team has about 60 minutes. But when it’s placed higher up, in the abdominal area, blood flow is halted to the kidneys and bowels, as well as the lower limbs. The team has only about 30 minutes before the organs will suffer from lack of oxygen.
“It’s a powerful tool, but it’s a bridge you can only have up for so long,” Dr. Chapman said. “It allows you to navigate those very difficult moments when you have low blood pressure, giving you time to figure out how to stop the bleeding.”
The bleeding stops
Don was taken to interventional radiology for an angiogram to discover the source of the bleeding. The surgeons deflated the REBOA balloon to allow blood flow.
“At that point, everything had stopped bleeding,” Dr. Chapman said.
Several factors may have caused the hemorrhaging to stop: the external fixation device on the pelvis, the pressure applied through packing the pelvis, and the REBOA. With reduced blood flow, a blood clot may have formed, Dr. Chapman said.
Not only did the device help stop the bleeding, it also restored Don’s blood pressure, keeping blood flow to vital organs—his heart, brain, kidneys and intestines.
Don remained in a critical state. He next went to the surgical intensive care unit, on a ventilator and recovering from his injuries and the effects of massive blood loss.
But in getting him to that point, the REBOA was crucial, Dr. Chapman said.
“I think the REBOA played a significant role in saving Don’s life and probably improving his outcome,” he said. “It definitely saved him from a significant blood transfusion.”
Five months after the accident, Don arrived at Dr. Gengler’s office for a follow-up visit, accompanied by his wife, Lois. Although using a wheelchair, he was able to walk with a walker. And he continued to receive physical therapy to recover from his injuries.
“You had two really bad injuries,” Dr. Gengler said. “It takes a while to get back from these things.”
Looking back on his accident, Don said he was not the only one on the snowmobile when the crash occurred. His 32-year-old daughter, Carrie Sleight, was riding on the back of the sled. She suffered a broken arm. Don was glad she had recovered and returned to work.
Don, who repairs golf carts at home, plans to keep getting stronger and return to work someday, also.
He credited his trauma team with his survival. And he spoke with gratitude about his family’s help as he heals.
“You did a good job,” he told Dr. Gengler. “I have good people around me.”
“It feels great to see you get better,” Dr. Gengler said. “It’s why we do what we do.”
A team effort
Bringing the REBOA to Spectrum Health trauma care took about nine months of preparation and training.
Because the device is used only in rare cases, the trauma team continues to host regular REBOA training sessions. Every few months, the surgeons, residents, nursing staff come together for a REBOA simulation, in which they use the device on a patient mannequin.
“This is a low-volume, high-impact procedure,” Dr. Chapman said. “We take our simulations very, very seriously.”
Involving the entire team is crucial, he said, because caring for a severely injured trauma patient requires a team effort.
“It’s never because of an individual that a trauma patient does well,” Dr. Chapman said. “It’s always because of a team.”