The Green Channel of Life

Arguably the greatest source of stress while traveling abroad for business or pleasure is experiencing sickness or emergencies in a place where your loved ones and adequate language skills are painfully absent. In February 2013, immediately upon landing at the airport, a Japanese traveler experienced a sudden intense headache and nausea and subsequently fainted. He was rushed to the Emergency Room at Beijing United Family Hospital (BJU). Upon arriving, ER staff could not detect the patient’s heartbeat or breathing. After performing cardiopulmonary resuscitation (CPR) and a head CT scan, the physician discovered that the patient was suffering subarachnoid hemorrhage (internal bleeding between the brain and its membrane) and acute hydrocephalus (collection of water in the brain). These symptoms are typical of hemorrhaging caused by an intracranial aneurysm.

An intracranial aneurysm is a weakening/thinning of a cranial artery wall that causes the artery to gradually enlarge over time, forming a bulge in the blood vessel. Blood pressure in this part of the vessel starts to increase and could eventually rupture the artery, which is what happened to the Japanese patient. According to international standards, there are five Hunt-Hess level classifications for intracranial aneurysms (Level 5=near death). Upon arrival, the Japanese patient was between Level 4 and Level 5. The BJU Green Channel for cerebral vascular diseases was employed. Neurosurgeons arrived at the ER within five minutes. Within 90 minutes, all relevant personnel had arrived and emergency treatment was underway.  According to the gold standard of intracranial aneurysm diagnosis, the neurosurgeon ordered a cerebral angiography of the patient to confirm whether the subarachnoid hemorrhage was due to an intracranial aneurysm. He discovered that the parent artery feeding the vessel with the aneurysm contained a thrombosis (blood clot).

While the patient received emergency treatment, BJU Japanese patient service officers found a way to contact the patient’s family in Japan. In the four hours before the patient’s family arrived, the neurosurgeon drained cerebrospinal fluid from the patient’s lateral ventricles (compartments within the brain) to alleviate his severe hydrocephalus and prepared to perform interventional embolization in the artery. However, within these four hours, the neurosurgeon noticed on the angiogram that the parent artery had used the thrombosis to close itself off, thus preventing the patient’s condition from worsening. Stabilized, the patient was immediately transferred to the Intensive Care Unit (ICU) for monitoring and treatment of complications. He regained consciousness the next day.

During this time, leader of the Neurosurgery team Dr. Ling Feng kept experiencing an unsettling feeling. Mortality rates from the first aneurysmal rupture were relatively low. However, if the rupture is improperly treated, mortality rates from the second rupture skyrocket to between 60% and 70%. Mortality rates from a third rupture can be 85% or higher. Professional sensibility made Dr. Ling order a CT angiography to determine whether the clot in the parent artery would stay put. Unfortunately, Dr. Ling saw what she had feared: the clot was starting to unravel. Cerebrovascular disease specialist Dr. Zhang Hongqi immediately performed an emergency embolization procedure and kept the patient’s life from being threatened again.

Three days after the embolization, the patient was discharged from BJU and escorted back to Japan by his family. Because the aneurysm occurred at an extremely rare site, and because the patient would be at highest risk for brain edema five to seven days after the rupture, Dr. Ling contacted the most renowned cerebral vascular disease specialist in Japan to ensure the patient would receive follow-up treatment and care after returning home.

The time between the patient’s arrival at BJU to his discharge from the hospital in the care of his family was only seven days. This eventful week saw incredible teamwork between Emergency, Radiology, Catheterization Lab and Neurosurgery staff members that resulted in accurate diagnoses and timely responses that pulled the patient twice from the brink of death. Staff of the Green Channel for cerebral vascular diseases, Catheterization Lab and ICU seamlessly coordinated the patient’s diagnosis, treatment and recovery, making inter-hospital transfers unnecessary. Tirelessly laboring alongside these teams, the Patient Services Department shouldered all responsibility for communicating between hospital staff and the patient/patient’s family as well as making every effort to give the patient and his family the best healthcare experience possible. With the help of Dr. Ling, the patient has already started follow-up treatment in Japan and is well on his way to recovery.

Information compiled from BJU Neurosurgery review conference and an interview with Dr. Nie Qingbin