PreviousStanford Children’s transforms high-risk trauma into remarkable outcome for Nevada boy
In Fallon, Nevada, ATVs are a part of life. The rural desert community is proud of its hundreds of miles of dirt roads and trails for riding. On a warm spring day, 15-year-old Dakota Sullivan was on his ATV enjoying a ride when he hit a mile marker at high speed. The impact injured his neck and threatened his life. Against all odds, he is alive and well today to share his story.
“I don’t really remember the crash, but I remember afterwards texting my friends and asking for help before I blacked out,” he says.
Thankfully, a stranger came by and drove Dakota to a local hospital, where he was airlifted to a larger hospital in Reno. There, a skilled team treated his injuries, which were severe. They determined he needed Level I trauma care and lifesaving airway reconstruction, so they contacted Stanford Medicine Children’s Health.
“Dakota’s trachea (airway) was completely transected, and the ends of it were shattered into fragments,” says Karthik Balakrishnan, MD, pediatric otolaryngologist and surgeon in chief at Stanford Medicine Children’s Health. The bottom of Dakota’s trachea had retracted into his chest, and there was a 5 cm gap from the top piece.
The Reno team placed an endotracheal tube (a breathing tube to help his lungs inflate and deflate), but because of the gap in the trachea, air was not directing well into the lungs. “He had to be paralyzed because just one movement could shift the tube just a little bit, which could mean no air going into his lungs and oxygen loss to his brain,” says Peggy Han, MD, pediatric critical care doctor in the intensive care unit (ICU) at Stanford Children’s.
Transporting Dakota on ECMO to Stanford Children’s Health
To survive transport to Stanford Children’s, Dakota needed the highest level of critical care support available: extracorporeal membrane oxygenation (ECMO). ECMO is a sophisticated machine that pumps and oxygenates blood outside the body, and it acted as Dakota’s lungs. It is only available at large children’s hospitals.
Stanford Children’s doesn’t typically send an ECMO team out to another hospital, but they did in this case because they knew it was the only way Dakota would survive.
“Transporting a patient on ECMO is no small feat. It’s highly complicated and difficult, and we knew transport itself could be life-threatening. With one false move he would likely die, despite being in the hands of our really well-trained team,” Dr. Han says. “I can’t say enough about how seamlessly our critical care transport team performed to get him here safely.”
Dakota’s family was by his side when the ECMO team arrived. “I thanked them for coming to get him, and they said, ‘Don’t worry, it’s what we do. We save lives.’ And that’s what they did. They saved my baby’s life,” says Deana, Dakota’s mom.
“Our Level I Pediatric Trauma Center is multidisciplinary and one of only five Level I pediatric trauma centers in California,” adds Stephanie Chao, MD, pediatric surgeon and director of the Trauma Center.
Discovering complex airway and esophageal injuries
A large team of pediatric general surgeons, otolaryngologists (ENTs), and critical care doctors were waiting for Dakota upon his arrival. Once the critical care team ensured that he was in stable condition, he was rushed into the operating room to assess his injuries. That was when Dr. Balakrishnan, a renowned Aerodigestive and Airway Reconstruction surgeon, discovered that Dakota’s trachea was completely severed. When he inserted a bronchoscope to view Dakota’s trachea, he could see into Dakota’s chest because the bottom was missing.
The same thing happened with esophagoscopy, which was performed to see if Dakota also had an esophageal injury. “In passing the camera beyond his throat into his esophagus, the first thing I saw was the airway tube in his chest, outside the esophagus, so it was clear he had an esophageal injury as well,” says Gillian Fell, MD, pediatric general surgeon.
Dakota’s esophagus (the tube that connects the mouth and stomach) was severed, with a flap hanging down. The surgical team also discovered a large tear in the wall of the back of his throat (pharynx). Thankfully, Dakota’s voice box (larynx) was unharmed, but it was broken off from the trachea.
“Dakota was incredibly lucky to survive the injury. The Reno team deserves credit for doing a terrific job of stabilizing him and being open to collaborating with us,” Dr. Balakrishnan says.
Straight into emergency surgery
After creating a care plan with multiple experts, the surgeons began an 11-hour operation to repair Dakota’s trachea and esophagus, with the help of pediatric anesthesiologists and perfusionists who kept him safely on ECMO.
In the meantime, Deana was driving from Reno to Palo Alto. “I hadn’t yet arrived, and I got a call from the surgeons, who each went around and said their name and explained what they were going to do,” Deana says. “They were amazing. I had no idea how the esophagus and trachea worked, but they made sure I understood everything.”
The repairs were high-risk and complex, and Dr. Balakrishnan and Dr. Fell worked side by side, along with several other experts, to save Dakota’s life. His esophageal injury occurred in one of the worst places—the very top of the esophagus, where it’s difficult to reach and see. “It’s the hardest part of the esophagus to repair. I called several of my general surgery colleagues in to make sure the esophageal repair was the right approach because it was not a straightforward injury,” Dr. Fell says.
Dr. Balakrishnan had to pull up the lower part of the trachea and reattach it to the upper part, which required removing shattered tissue and borrowing other tissue from Dakota’s leg to reinforce the repair. He also repaired the tear in Dakota’s pharynx.
“The operation went smoothly, better than we could have even hoped,” Dr. Balakrishnan says. “It was difficult, but the good news is that we have a lot of experience putting kids’ tracheas and esophaguses back together.”
“Trauma cases can be unpredictable, and demand good communication and team-based flexibility. This can be challenging to achieve. Even though this was an incredibly complex case, with a very large team and many things happening simultaneously in the operating room, every single person stepped up in a focused way and did their job. That’s something that is common here at Stanford Children’s,” Dr. Fell says.
A remarkably short hospital stay and smooth recovery
Dakota spent just two months in the hospital. He healed surprisingly well. “We honestly expected it to be more like four or five months,” Dr. Balakrishnan says.
One reason for Dakota’s outstanding outcome is Stanford Children’s Health’s collaborative culture of bringing multiple specialists together and working as one with a single focus: to provide the very best outcome for the patient.
Dakota was cared for by more than a dozen specialized teams. At first, it was the ECMO team and doctors from critical care, ENT, airway reconstruction, general surgery, nursing, and anesthesiology who treated his trauma and injuries. Then, the rehab teams kicked in, along with gastroenterology, including respiratory therapy, nutrition, occupational therapy, speech-language pathology, Child Life, and social services. All along the way, advanced practice professionals from general surgery guided his care. “There were so many teams caring for him that it’s hard to think of one that wasn’t involved!” Dr. Fell says.
Dr. Han also credits Dakota himself for his great outcome. “He had this dogged determination to get better, and his family was so supportive. They put their trust in us,” she says. She recalls a time when Dakota was intubated in the ICU, but he was still up doing his exercises. “He recognized his role in partnering to improve his own health, and he never had a bad attitude.”
When asked why he didn’t give up or get down or grumpy, like a teenager might do, Dakota mentioned his grandma. “She had been through a lot of health stuff. For a while, she was on life support and couldn’t drink liquids either, so I thought if my grandma made it through, I could too,” he says.
Doctors gave Dakota a tracheostomy (an opening in his trachea through the neck) to help him breathe better and placed a feeding tube to give him nutrition while his esophagus healed. Deana is grateful for Dr. Balakrishnan’s innovative approach to tailor care for Dakota; he designed a special breathing apparatus for him, since the ones available were too small and too short.
“It was so amazing. Every day he got better,” Deana says.
Dakota recalls being terribly thirsty when he couldn’t eat or drink by mouth. “When the team finally said he could drink and gave him apple juice, he said, ‘Mom! This apple juice explodes in your mouth!’ A few days later he was eating everything,” Deana says.
To get through each day, Dakota focused on his daily routine of self-care, exercises, and team care visits. “It helped me keep my mind off everything,” he says. The family was unexpectedly surprised by the extras that Stanford Children’s provides. Dakota and Deana attended The Prom and the premiere of Inside Out 2, put on by Child Life and Creative Arts. “When I had to go back home for a bit, I was really upset, and the Child Life team said they would come see him, and they did, every single day,” Deana says.
With esophageal injuries, there tends to be a narrowing of repaired tissue, but Dr. Fell is happy that Dakota is experiencing only minimal narrowing. And there was worry that he might have paralyzed vocal cords, but he was able to recover his voice, just at a slightly higher pitch.
“I’m so proud of how strong Dakota was. He didn’t get depressed, he just took whatever came his way,” Deana says.
Home and back to normal life
It has been three months since Dakota’s accident, and he’s home in Fallon, Nevada, enjoying the beginning of fall. He started online school, and he is back hanging out with his tight group of friends, who Deana describes as “all good boys.” He hasn’t experienced any complications or difficulty since returning home.
“The accident didn’t change my life, it just made my voice different,” Dakota says.
Learn more about Trauma Care at Stanford Children’s >
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- Lynn Nichols
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