It was lunchtime and Vivian Juarez, of Everett, Mass., had sat down to feed her 7-week-old son, Lucas. Lucas, normally a happy and hungry baby, would not eat and started to vomit. Vivian and her husband, Elmer, knew something wasn’t right, so they took Lucas to his pediatrician’s office. There, a nurse took his vital signs and noticed his heart rate was nearly double that of a typical baby his age.
Lucas was then rushed to the Emergency Department (ED) at MassGeneral Hospital for Children (MGHfC). In the ED, he was struggling to breathe and his blood pressure was low. Doctors started an IV, intubated him and tried to increase his blood pressure with medications. Lucas had gone into cardiogenic shock, a condition in which the heart cannot pump enough blood throughout the body. His condition was caused by supraventricular tachycardia, or SVT, a rare condition that causes episodes of a fast heart rate caused by extra electrical conduction tissue in the heart.
“His heart muscle was very fatigued. I describe it as running a marathon for days on end,” said Manuella Lahoud-Rahme, MD, a pediatric cardiologist and intensivist who cared for Lucas. “His heart rate was very high for such a little baby, around 280 beats per minute. As his heart muscle fatigued, his organs were not getting enough blood supply throughout his body, including to his brain.”
After trials of IV medications, 12 electrical shocks with a defibrillator and short periods of chest compressions, it was obvious that Lucas needed more help. He was placed on mechanical support in the ED called extracorporeal membrane oxygenation (ECMO). ECMO acts as a heart and lung bypass machine that allows the body to rest by doing the job of the heart and lungs. Without it, Lucas would have died.
Lucas was then transferred to the Pediatric Intensive Care Unit (PICU), where Lahoud-Rahme and the rest of the medical and surgical team had to find ways to control the SVT and allow his whole body to recover, including his brain. Five days into his hospital stay, Lucas recovered well and was taken off ECMO.
Throughout his three-week stay in the PICU and one week on Ellison 17, Vivian stood by her son, buoyed by the care of Lahoud-Rahme and countless other providers, nurses and staff. “This hospital was my home for four weeks. It was so scary and he was so little,” said Vivian. “There were so many people who gave such good care to Lucas and without them, I wouldn’t have my son.”
This past February, Lucas turned 1 and his heart condition is managed with two medications. “Looking at him now, you’d never know he was so sick,” said Vivian. “He is healthy and he is just the happiest baby. All he does is smile.”
Now, Vivian brings Lucas in for regular follow-ups with Lahoud-Rahme, who developed a close relationship with the family during Lucas’s hospital stay. “We are a family-centered hospital, which means the family sees everything we do for our patients. In Lucas’s case, Vivian and Elmer witnessed placement of the IV, the intubation, the chest compressions and the placement on ECMO,” said Lahoud-Rahme. “When you have a connection with a patient like Lucas, he really holds a special place in your heart.”
In more than 90 percent of babies with SVT, said Lahoud-Rahme, the issue resolves by itself by the time they are 18 months old. In the other 10 percent, it can happen again and can be managed with medications or a procedure in the electrophysiology lab. “Lucas’s future is bright,” she said. “He really is what you would call a miracle baby.”