Heart op on floor of pub saves life

A DOCTOR who saved the life of a man dying from a stab wound by performing open-heart surgery on the floor of a crowded pub said yesterday she felt "fantastic" that the gamble had paid off.

Stephen Niland, 22, was lying in his own blood when Dr Heather Clark, 35, a specialist registrar with the Helicopter Emergency Medical Service at the Royal London Hospital, arrived at The Swan pub in Stratford, east London where he had been assaulted. An ambulance crew were rigging up drips and trying to resuscitate him, but it was immediately clear to the doctor that emergency surgery was necessary.

Dr Clark said: "He was barely conscious and hardly breathing. I made two holes using a scalpel blade on either side of his chest to relieve the pressure on his lungs. The lungs are in a sac and if you get a wound through the chest, the cavity can fill with air squeezing the lungs so you make the holes to relieve the pressure. It is a standard procedure we do quite often."

Seconds later, however, Mr Niland lapsed into a coma and Dr Clark and her colleague, Dr Alistair Mulcahy, could not find a pulse. She knew that the only chance of saving him was to get at the heart and repair the damage, but she had learnt the technique only two days earlier when a colleague had performed it on the victim of a shooting incident. That time the operation had been carried out on the floor of an office but the patient had died.

"I said to Alistair, `We need to open his chest' There was no doubt in my mind that this was what he needed. He was effectively dead," she said.

While her colleague gave him an anaesthetic, Dr Clark cut the skin across the chest with a scalpel just below the nipple line and then used a pair of heavy-duty scissors to cut through the sternum (the breast bone), to allow the chest to be opened in what is known as a thoracotomy, or clam-shell procedure.

"It is very hard work and quite slow and time is of the essence. After I started I asked Alistair to use his scissors to cut from the other side to speed it up," she said.

As a crowd of onlookers watched the bar-room surgery, Dr Clark lifted the ribcage to expose the heart and lungs and cut the sac surrounding the heart, into which blood and clots caused by the stab wound had leaked. "As I cut it open quite a lot of blood and clots came out. You have to release them because the pressure can stop the heart.

"I was about to massage it to get it going when it started again. Then we saw a little fountain of blood where the heart had been pierced and Alistair stopped it with his finger. He held it there for an hour while the patient was transferred to hospital. Once he was in theatre it was a fairly simple procedure to stitch him up."

The incident happened on 16 April, but details were not released until yesterday. Mr Niland left hospital six days later and is expected to make a complete recovery.

Although similar surgery has been attempted on several occasions, Mr Niland is believed to be only the fourth patient to survive an emergency thoracotomy performed outside hospital, and only the third to recover without brain damage.

Dr Clark, who hopes to become a consultant in accident and emergency medicine, said: "It's just fantastic. It is better for us than for anybody. I am just ecstatic that he is alive and well."

She said that the outcome was testimony to the success of the new approach in emergency care of giving treatment at the scene. This has replaced the old policy of "scoop and run" - picking victims up and rushing them to hospital.

"Ours is the only service that sends a doctor out to treat patients where they are injured. It saves a huge number of lives," she said.

Dr Clark and Dr Mulcahy had been drinking cups of coffee at the end of their shift at about 7.50pm when the call came through about a stabbing at the pub in Stratford. The helicopter was out of service after 7pm but the doctors had access to a rapid response car and were at the pub shortly after 8pm.

"Officially we were off duty, but we are doctors so of course we went. We were on the scene the second his heart stopped. That is what saved his life," Dr Clark said.