As is often the case with emergencies, this one arrived at 5 p.m. on a Friday. The referring veterinarian had called a half hour earlier and described a patient that had been deteriorating rapidly.
It was a 3-pound kitten named Wrigley that had a congenital softening and narrowing of the trachea. Her breathing was now so impaired that her vet was concerned she would not last through the night, much less the weekend. This was now a full-blown emergency.
The problem became acutely apparent when she was being anesthetized for a routine spay surgery. The tube that was being placed into the trachea to deliver oxygen and anesthetic ran into something unexpected, a stricture, or narrowing. This abruptly stopped the tubes advancement and caused some bleeding.
Because the tube was wedged into the stricture, the flow of oxygen was seriously impeded, and the blood quickly occupied what room remained. Things deteriorated rapidly from there. The kitten went into a full cardiac arrest. Without an immediate and effective cardiopulmonary resuscitation, Wrigley would be beyond help in a few minutes.
CPR is tricky in cats. The goal is to compress their hearts, to circulate blood, and to breathe for them, in this case through the tube, to provide oxygen. But cat’s hearts and lungs are sensitive. If CPR is prolonged or rough, one risks damaging these vital tissues rendering them nonfunctional. Such is the case in any cat, but this cat weighed just 3 pounds, and its airway was severely abnormal.
Most of the time we will discontinue CPR after about seven minutes, sometimes 10, all depending upon response. Wrigley’s vet refused to give up and continued for 35 minutes. That’s when her little heart began to beat and she managed to breathe. She lost her eyesight and was a bit uncoordinated, but she was alive.
Unfortunately, her stricture closed gradually over the ensuing two weeks, until it was nearly closed. She came through the doors to our office gasping and her lips and tongue were blue. We placed her immediately into an oxygen cage, where she just barely clung to life.
Her X-rays indicated a trachea that was nearly completely closed. Wrigley was in surgery within the hour. The strictured segment of trachea was identified and removed. The remaining trachea was put together, but there seemed to be a problem.
In addition to this stricture, the adjacent cartilage was softer than normal and appeared to flatten, causing yet another possible narrowing of the trachea.
X-rays confirmed our concerns. The trachea was collapsing in the area of the re-section. We hoped that some of the narrowing was due to inflammation and swelling, and that it might resolve. Her breathing was a bit better, so we watched and waited.
Every eight hours, she was placed into our hyperbaric oxygen chamber. This exposes them to an oxygen-rich environment under pressure. This delivers oxygen to the surgery site and can reduce swelling. While in the chamber, Wrigley didn’t struggle to breathe, as the oxygen permeated her tissues. But, shortly after emerging, her struggles would resume.
It was a huge, heartbreaking, weight on us all — Wrigley’s owners, her vet, me (Bianucci) and my staff — to watch this brave little kitten struggle for breath. Her condition was not improving and her trachea remained seriously narrowed.
On Saturday afternoon, it appeared that the fight was over. I was called by the ICU doctor to come immediately to the ward. As I arrived, I was told that her breathing had significantly worsened. As I examined her, she went rigid. Her pupils became fixed and dilated and she stopped breathing. Her heart quickly stopped beating and I decided that to perform CPR again, with no way to immediately correct the underlying issue, would just prolong her suffering.
I called her owner, and then her vet with the sad news. As I hung up the phone, our ICU doctor rushed into my office, “Dr. B, we didn’t do CPR. We just moved her and she suddenly took a breath, and her heart started beating spontaneously.”
Then my phone rang. It was the front desk, “Dr. B, Wrigley’s owners are here.” Their expressions were resolute, sad, but accepting. Then I had to tell them that their cat was still with us, or more accurately, had returned to us. The funny thing was, her owners were not shocked. The mom said, “See she’s a fighter, she’s not ready to go”
I dreaded calling her vet about the resurrection, but he was similarly nonplussed, recounting his experience reviving her.
We decided to give it another day. Back into hyperbaric oxygen she went, but there was no improvement. I could not sleep that night. I kept waking up and thinking of that little fighter struggling for each breath. I went to the clinic Sunday morning and examined her.
Still struggling, looking worn out, I repeated an X-ray. No change. I gazed at the film and that horrible narrowing and considered options. There was only one thing that would help, a stent.
Stents are basically wire mesh cylinders that are placed in a collapsing trachea to support it from inside.
The problem is that they are expensive and we could not have one delivered for another 48 hours. Wrigley didn’t have that long. I pored through our supplies and the best I could find was a stent made to open a human bile duct. The size was about right and it was our only shot.
I discussed it with the owners and expressed that we had to try the stent. If it failed, we had to let her go, but she could not go on like this. They agreed. I consulted with my associate surgeons, Drs. Lori Ludwig and Mike Schlicksup, and with the assistance of the latter, deployed the stent. It was perfect, at least as perfect as we could have hoped. Wrigley’s breathing capacity was immediately restored. By that evening, she was eating, walking and purring. Two days later, she was home.
Wrigley has a ways to go before she is out of the woods, so it’s too soon to proclaim success. But, what I love about this story is the energy and teamwork that went into it and the way no one, including the patient, was willing to give up. It was this collection of wills and efforts, each inspiring the other, that resulted in this improbable outcome.
It would have been completely reasonable to stop at any of a number of rough spots along the way. But prayers, persistence and fighting spirits gave us not only a wonderful result but an enriching experience.
Dr. Henri Bianucci and Dr. Perry Jameson are with Veterinary Specialty Care LLC. Send questions to firstname.lastname@example.org.