Life and Death Pitstop

[Guest guest]

Ferrari pit stop saves Alexander's life

By William Greaves

 

(Filed: 29/08/2006)

 

As 18-month-old Alexander Barham was wheeled into

intensive care, his survival depended on the expertise

of the medical specialists all around him and, in no

small part, on the split-second precision of the

Ferrari Formula One motor racing team.

 

Prof Martin Elliott had just performed a three-hour

hole-in-the-heart operation and watched in silence as

three members of his surgical team began the practised

routine of coupling a bewilderment of tubes to drug

supply, ventilation and monitoring equipment above the

young patient's head.

 

Techniques developed from Formula One pit technicians

were silently put in place after the operation on

Alexander Barham

 

" This is perhaps the most critical stage of the

operation and a year or two ago it would have been

full of noise and movement as everyone, including me,

got into the action, often getting in each other's

way, " he whispered. " But that was before our research

work with Ferrari transformed the way we work. "

 

It was after what he described as " a particularly bad

day at the office " that Prof Elliott, the head of

cardiac surgery at the Great Ormond Street Hospital

for Children, and his colleague, Dr Allan Goldman, in

charge of paediatric cardiac intensive care, slumped

into chairs in front of the television.

 

On the screen was a motor racing grand prix and, as

they watched, the two men became aware of the

similarities between the handover disciplines from

theatre to intensive care and what they were seeing in

the pit of a Formula One racing team.

 

From that moment began a collaboration between the

leaders of Great Ormond Street's surgical and

intensive care units, first with the McLaren F1 racing

team and then with Ferrari's team chief Jan Todt,

technical guru Ross Brawn and, in particular, race

technical director Nigel Stepney.

 

They worked together at their home base in Modena,

Italy, in the pits of the British Grand Prix and in

the Great Ormond Street theatre and intensive care

ward.

 

The major restructuring of the patient handover

procedure, resulting directly from the input of the F1

pit technicians, will soon be described in two

scientific publications.

 

" It is not too early to say that, when we look at the

number of critical instances we encounter, they have

reduced markedly since we introduced the modified

training protocol developed from what we have learned

from Formula 1, " said Prof Elliott.

 

The single A4 sheet of paper, which contained the flow

diagram of Ferrari's pit procedure, became several

pages of twice that size when Mr Stepney and his

colleagues at Ferrari were confronted with the

critical transfer from operating theatre to recovery

room at Great Ormond Street.

 

" They were quite shocked at the complexity of what we

did and the kind of kit we had at our disposal, " said

Prof Elliott. " They saw us operating on a solid table

with the child under a heating or cooling blanket and

all the vital connections to the various bits of

equipment and then having to unplug everything and use

a hand-operated ventilator as we took the patient out

of the theatre, into the lift and along the corridor

to intensive care.

 

" Their first thought was why didn't we do everything

on a bed trolley that was equipped with everything we

needed and didn't require disconnecting and

reconnecting.

 

" I pointed out that the manufacturer did not exist who

would invest that sort of money in such a specialised

product and that's when they started investigating

human solutions and training methods to solve our

problems. "

 

He spoke as his surgical team went through the

structured process of connecting Alexander to exactly

the same life-sustaining equipment which had seen him

through the highly invasive ToF - Tetralogy of Fallot

- repair operation he had undergone in the operating

theatre.

 

" Alexander was born with a hole between the left and

right ventricles - the heart's main pumping chambers -

and the way out of the right ventricle was narrow and

muscle-bound, so we had to put a patch to close the

hole, divide the muscles and enlarge the pulmonary

valve, " said the surgeon.

 

" It's something we do between 20 to 40 times a year

but I've just bashed his heart about pretty

drastically and I want to get to him to feel his brow,

fingers and toes because, as always at this stage, he

looks very pale.

 

" You'll notice that not a word is being spoken while

he's being connected up. The nurse and doctor who'll

be with him throughout the night are taking notes from

the information being displayed … now our consultant

anaesthetist is with Dr Anne Karimova, the head

intensivist … all the portable equipment is now being

removed … there go the bleeps as all the alarms come

on line … another sister moves in to check the drains

and urine outlet … still not a word. "

 

At last comes the moment when Prof Elliott can stride

forward to lay inquiring fingers on his tiny patient.

 

" We had all being doing our jobs for years and we

thought we were pretty good at it, " said Dr Nick

Pigott, the consultant in paediatric cardiac intensive

care, who has worked alongside Prof Elliott and Dr

Goldman throughout Operation Pit Stop. " Then, after we

had been with the Ferrari team, we watched videos of

ourselves at work and it was quite a shock to realise

the lack of structure in what we were doing.

 

" Under Prof Elliott's predecessor, we had been working

for some time with the aviation industry. But there is

no doubt that it is our research with Ferrari that has

honed our transfer from theatre to intensive care to

the level of silent precision it is today. "

 

With a greater success rate? " Numbers are too small to

claim a reduction in mortality but there is no doubt

that we now have a reduction in morbidity - that is to

say, illnesses that the patient did not come in with, "

said Dr Pigott.

 

Back in his natural habitat masterminding Ferrari's

first and third place finish in Sunday's Turkish Grand

Prix, Mr Stepney had only admiration for Prof Elliott

and his colleagues.

 

" My wife and I have a seven-week-old daughter and,

frankly, I scarcely dare think of what those people

are doing with hearts no bigger than walnuts. I hope

we've taught them something useful, because what

they've taught us is humility.

 

" It takes a long time to establish a team. We have

twenty-odd people working together for four to six

years to get a routine which lasts little more than

four seconds. They work round the clock, every day,

with ever-changing personnel, so what they need is a

formula to work to. "

 

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