SACRAMENTO — Jordan Herbst, a 14-year-old Bishop boy, is at home recovering from a life-threatening and rare hantavirus infection, thanks to the efforts of pediatric specialists at hospitals in Nevada and at UC Davis Children’s Hospital.
They included a UCD critical care transport team that hand-ventilated Jordan for more than two hours while he was airlifted to Sacramento from Reno.
Hantavirus is exceptionally rare. It is transmitted almost exclusively by contact with rodent excrement or urine. Only 55 cases have been confirmed in California, according to the U.S. Centers for Disease Control and Prevention.
Jordan began to feel sick on Aug. 10, while returning to Bishop from a vacation in Eugene, Ore., with his mother, Katharine Allen, co-president of InterpretAmerica, a translation and interpreting business. With a population of about 4,000, Bishop sits in the northern part of Inyo County, at the northern end of the Owens Valley, with the Sierra Nevada to the west and White Mountains to the east.
Allen recalled that her son had been feeling under the weather throughout the two-day road trip home. She thought he had a virus, possibly the flu.
“On both days of the drive he was complaining of feeling achy and kind of feverish. I thought, ‘Well, he’s either getting a cold, or he’s tired from all of the driving,’ ” she said. “Still, he was pretty perky until he went to bed on Sunday night.”
Jordan became nauseous and began vomiting shortly after midnight. Allen said she decided to spend the night in her son’s bedroom because he felt so bad. His temperature hovered at around 103 degrees.
He seemed to be feeling better the next morning, though, and she thought that he had “sweated out” the fever.
That evening, however, his fever returned and she spent another night with her son.
But early on the morning of Aug. 13, Allen said she could see that her son was struggling for oxygen. His breathing was rapid and shallow, and his heart was racing.
She had called the local clinic for advice. The nurse there was a survivor of hantavirus and suspicious of flu symptoms in the summertime. She referred Jordan to the local emergency department at Northern Inyo County Hospital, a 25-bed hospital in Bishop.
The physician suggested that Jordan, who had been a healthy, active and athletic teenager, might have pneumonia and immediately placed him on oxygen. Doctors there drew Jordan’s blood, took X-rays of his chest and found that both of his lungs were filling with fluid.
Jordan’s father, David Herbst, a research scientist with the University of California’s Sierra Nevada Aquatic Research Lab and a UCD alumnus, joined Jordan and his mother at the hospital emergency department.
The first airlift
The doctors told the parents that, although he was young, healthy and strong and could handle struggling to breathe for a long time, eventually that struggle would exhaust him. He would need medical support not available at the local hospital.
Fearing that moment was imminent, they immediately made arrangements to have Jordan airlifted to Renown Regional Medical Center in Reno.
Because there was room for only one person to accompany Jordan in the aircraft, his mother traveled with him. David Herbst and Jordan’s sister, Anna, 17, made the four-hour drive to Reno.
The Renown staff placed Jordan on oxygen and medications, but eventually had to sedate and intubate him and place him on a ventilator. Intravenous lines were placed in his arms and into his femoral artery.
At this point, despite their determined efforts, the physicians at Renown barely were keeping Jordan alive. His blood pressure and oxygen levels had “crashed.”
“We stayed up with him throughout the night as his blood pressure and blood oxygen remained at dangerously low levels,” Herbst said.
Then, in the early morning hours of Aug. 14, Jordan’s doctors spoke with his parents again. Their son was pale, blue and sedated.
“They said ‘We can’t manage this. You need to get him to a better-equipped hospital,’ ” Herbst recalled.
Dean Blumberg, chief of the division of pediatric infectious diseases at UCD Children’s Hospital, said the decision by doctors at Renown to transfer their patient was crucial to Jordan’s survival.
“One of the scariest aspects of hantavirus pulmonary syndrome is the dramatic clinical deterioration that occurs over the course of hours,” he said. “Despite maximal conventional supportive efforts, the respiratory failure relentlessly progresses.”
A second airlift
Physicians in Reno already had contacted UCD, which dispatched its Pediatric Critical Care Transport Team.
Darrell Griswold, a seasoned pediatric transport nurse, was on the team that arrived at the hospital at about 9 a.m. He told Jordan’s parents that it was difficult to stabilize him for transport.
And he had to give them more sobering news.
“He wasn’t able to maintain a blood pressure,” Griswold said. “He was pale and had really cold extremities. His oxygen saturations were in the 70s and 80s — really low. He was one of the most critically sick patients I’ve ever transported.
“I had to tell them that he was so sick, I didn’t know whether or not he would be able to survive the transport. That was really hard.”
But the transport team was determined to save Jordan. Griswold and another member of the team, transport nurse Ken Toles, would hand-ventilate — or “bag” — Jordan throughout the trip, from Renown to the fixed-wing airplane at the airport in Reno, throughout the flight to Executive Airport in Sacramento and then to UCD Children’s Hospital — for a total of about two hours.
“After two hours of driving,” Jordan’s father recalled, “I heard that he had arrived alive and had been taken to the Pediatric Intensive Care Unit. Within minutes of arriving at the hospital we heard over the intercom ‘code blue on Floor 10.’
“I rushed there to find his room filled with medical staff, busy in life-saving mode, that they had done CPR on Jordan for six minutes, and had just brought his heartbeat back after inserting a cannula into his heart to connect him with ECMO.
“He had been pale and blue when he left Reno,” Herbst said. “Now at least he was getting oxygen.”
A ‘miraculous save’
Herbst had witnessed his very sick son’s response to being placed on extra-corporeal life support, called ECLS or ECMO: technology reserved for patients who have at least a 75 percent chance of dying should they not have access to the procedure.
ECMO is used to provide pulmonary support to patients whose own lungs are so damaged that they cannot function properly.
In Jordan’s case, blood from his veins was circulated through the machine, re-oxygenated and then returned to the right side of his heart, pumping blood to his lungs and the rest of his body.
Herbst said that once Jordan no longer was struggling to breathe, his immune system could do the work of fighting off the hantavirus infection.
“What’s amazing about the medical technology at UC Davis is that you can line up all of these pieces of technology so that the net result is homeostasis,” he said. “It was really impressive to see it first-hand. It wasn’t just the technology; it was the knowledgeable and truly caring people who impressed me. From the doctors who were doing the work to support him, to the nurses and respiratory technicians.
“They accomplished a pretty miraculous save because they truly cared. Everybody was so stoked they saved Jordan’s life.”
A team effort
John Holcroft, assistant professor of pediatric critical-care medicine, was the attending physician when the young patient arrived in the intensive care unit:
“Upon Jordan’s arrival, he had waiting for him: a cardiothoracic surgeon, a cardiologist, an echosonographer, an ECLS perfusionist, several registered nurses (including one who called in from home to monitor the ECLS circuit), a respiratory therapist and administrative support.
“All of these people, working together, saved Jordan’s life, and that was just in the first few minutes of his arrival. Within hours, many other physicians, nurses and therapists continued to provide support.
“This is what we do here,” Holcroft continued. “We have the state-of-the-art equipment and the highly skilled people trained in its use who can treat the very sickest patients, often bringing them back from near death. I feel very glad to have been able to be a part of caring for Jordan, and am genuinely gratified that we were able to send him back home to his family and friends.”
Jordan remained on ECMO for about 60 hours.
In a rapid turnaround, he was ready to be discharged from the hospital five days later, on Aug. 27.
The teenager is expected to make a full recovery, though he will receive physical therapy to help him regain his strength. Throughout the ordeal he lost 10 pounds, most of it muscle.
“When the Pediatric Transport Team walked into Jordan’s room in Reno, we felt like the Navy SEALs had come to the rescue,” said Allen, who frequently works with hospital systems to help them improve care systems for non-English-speaking patients.
“I will be forever grateful to the many, many wonderful providers who first saved Jordan’s life, and then worked so tirelessly to limit any long-term negative outcomes from his near-death experience. They never lost sight of a future for him that included a complete recovery.
“Thanks to them, Jordan is home and solidly on the path back to a healthy, normal, teenage life. For us, it is a miracle.”
Jordan had one simple message for all of the doctors, nurses and others who cared for him, from Bishop to Reno to UCD.
“I’m very thankful I’m alive,” he said. “Thanks for saving my life.”
— UC Davis Health News Office