In just one day, the University Hospital October 12 He has had to face one of the most demanding days in his Pediatric Cardiac Surgery service. In a 24-hour period, his team successfully operated on three babies in life-threatening situations, distributed between Madrid, Castilla-La Mancha and Castilla y León, combining scheduled operations with emergency alerts from other public centers.
This deployment, which has required a millimeter-precise coordination between autonomous communitiesThis has tested the organizational and clinical capacity of a team composed of only four pediatric cardiac surgeons. Despite the complexity of the cases and the necessary travel, The three children are progressing favorably and only one of them remains hospitalized in conventional pediatric ward.
A deadline for pediatric heart surgery
The account of what happened begins with a surgery already scheduled in the operating rooms of the new 12 de Octubre building. The patient was a six-month-old infant with a complex congenital heart condition who had undergone surgery immediately after birth, as an intermediate step, while awaiting a definitive operation to correct his heart malformation.
This surgery, scheduled for a specific day last month, was part of the routine activity of a center that It performs around two hundred procedures annually. in newborns and children with complex heart conditions, which places it among the hospitals with the highest volume of this type of procedure in Spain.
However, the plan fell apart just a few hours before. One day before the scheduled operationThe University Hospital of Toledo, in Castilla-La Mancha, issued an urgent warning: a very premature baby of only 24 weeks of gestation and 600 grams in weight It presented with a patent ductus arteriosus that required a urgent cardiovascular surgery to close this abnormal blood vessel.
A patent ductus arteriosus, which connects the aorta to the pulmonary artery, is a condition that It directly affects the large blood vessels. And that, in serious cases like this, it requires rapid intervention to prevent irreversible deterioration of the baby's condition. The premature infant's condition made delaying action impossible and presented the Madrid team with a complex challenge: to take on Two highly complex surgeries in the same time slot and in various hospitals.
Two simultaneous operations in Madrid and Toledo
Given the urgency raised by Castilla-La Mancha, the Four pediatric cardiac surgeons from the 12 de Octubre Hospital They had to reorganize on the fly. As Dr. Lorenzo Boni, head of pediatric cardiac surgery at the center, explained, they decided split into two teams in order to cover both procedures without delays.
Two professionals stayed in Madrid to address the planned surgery of the six-month-old infantThe surgery was intended to permanently correct his congenital heart defect. Simultaneously, the other two surgeons traveled to the University Hospital of Toledo to operate on the patient. premature baby weighing 600 grams, in an extremely delicate operation due to both the low weight and the fragility of the patient.
In Toledo, the objective was to close the patent ductus arteriosusa duct that, if not closed in time in these types of patients, can cause severe heart and lung complications. The procedure, classified as complex cardiovascular surgeryIt required a high level of precision and close coordination with the local staff of the Castilian-La Mancha hospital.
Meanwhile, in Madrid, the scheduled procedure was progressing according to plan, with the 12 de Octubre team applying their experience in complex congenital heart diseaseAccording to sources from the Community of Madrid, both surgeries were successfully completed this morning, stabilizing the two children and confirming the viability of a flexible and fast organization even with such a small team.
Dr. Boni himself has acknowledged that achieving to operate on three patients in three different autonomous communities In such a short time, it posed a real "organizational challenge" for a service made up of only four professionals, who had to adapt almost by the minute to the clinical needs of each case.
Activation of the ECMO program for a baby with severe respiratory failure
The day, however, did not end with the two surgeries in the morning. Early in the afternoon, the University Hospital of Salamanca, in Castile and León, launched a new alert for a four-month-old baby who suffered a very severe respiratory failure and did not respond to conventional therapies, including intubation and mechanical ventilation.
Faced with this critical situation, on October 12th he activated his ECMO transport program (extracorporeal membrane oxygenation), of which it is national reference center (CSUR) for pediatric patients, in coordination with the SUMMA 112 emergency service. This protocol is only activated when All the usual therapeutic alternatives have failed and the patient's heart or lungs are unable to maintain adequate function on their own.
ECMO functions as a kind of external artificial heart and lungThe patient's blood is drawn through cannulas placed in the large blood vessels (usually the carotid artery and jugular vein, or the femoral vessels), oxygenated and carbon dioxide removed in an extracorporeal circuit, and then returned to the body, allowing the organism to stabilize.
To carry out this type of transfer, a highly trained multidisciplinary teamThe procedure involves pediatric cardiac surgeons, intensivists, perfusionists, specialized nursing staff, and professionals from SUMMA 112. They all travel to the child's originating hospital, in this case Salamanca, place the ECMO system on the child, stabilize them, and, once their vital signs are assured, perform the transfer by medical transport to Madrid.
According to what those in charge of the service would later explain, the patient presented a respiratory failure so severe that "the only realistic alternative" to get him to the 12 de Octubre Hospital was to use this portable cardiopulmonary support system. After arriving at the Madrid hospital, the baby was admitted to the Pediatric Intensive Care Unitwhere he remained for a time on ECMO support until it was possible to gradually begin removing the machine.
Results, development of the younger players and the role of 12 de Octubre
The three episodes, concentrated in a 24-hour period, have had a favorable clinical outcome for the children involved, as confirmed by both the Community of Madrid and the hospital itself. All three babies have responded positively to the procedures and subsequent treatment, and only the four-month-old infant The patient who required ECMO remains hospitalized, now in conventional pediatric hospitalization, awaiting full recovery to return home.
In this type of painting, the process of ECMO machine weaning This process can last for several weeks, as it is necessary to very carefully check that the heart and lungs are functioning independently and stably again. The medical team estimates that further interventions may still be required. Two or three weeks additional intensive follow-up before final discharge.
Beyond the immediate impact on healthcare, this chain of actions once again underlines the The role of the 12 de Octubre Hospital as a reference center in highly complex pediatric cardiac surgeries within the public healthcare system. Its status as a leading hospital in neonatal surgeries, its experience in ECMO transfers, and its regular collaboration with other centers in different autonomous communities have made it a a key point of the Spanish healthcare network for the most serious cases.
This is not the first time this Madrid hospital has taken on challenges of this magnitude. About a year ago, for example, its Pediatric Cardiac Surgery team traveled outside the region to operate on a premature baby weighing just 800 grams with a severe heart defect. On that occasion, the operation had to be performed in the Neonatal Intensive Care Unit from the center of origin instead of in a conventional operating room, and the technique used was also ductus ligation, an extremely complex intervention in such a fragile patient.
Cases like these illustrate how the cooperation between autonomous communitiesThe deployment of highly specialized teams and the availability of advanced technology, such as ECMO, allow the public healthcare system to offer highly sophisticated responses even in extreme situations. For families, who are experiencing these hours with enormous emotional stress, having a coordinated and effective healthcare system and Tips for caring for children's emotional well-being It makes a clear difference in the development and prognosis of their children.
What happened in those 24 hours at the 12 de Octubre Hospital paints a fairly clear picture: with a small but highly qualified team, a good collaborative network with hospitals in Toledo and Salamanca, and resources such as ECMO transport, the public healthcare in Madrid and the rest of Spain It is capable of responding to extremely high-risk pediatric emergencies and of successfully handling cases that, not so long ago, would have had a very different outcome.
